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Class _SlLieJ_ 
Book____iir__ 



CoipgMlf^aSJjt 



CDFXRIGHT DEPOSm 



THE CARE AND FEEDING 
OF CHILDREN 

A CATECHISM FOR THE USE OF MOTHERS 
AND CHILDREN'S NURSES 



^ yr' BY 

L. EMMETT HOLT, M.D., LL.D. 

PROFESSOR OF DISEASES OF CHILDREN IN THE COLLEGE OF PHYSICIANS 

AND S-CTRGEONS (COLUMBIA UNIVERSITY) 

ATTENDING PHYSICIAN TO THE BABIES' HOSPITAL AND THE 

FOUNDLING HOSPITAL, NEW YORK 



^ebentij Cbition, l^ebiseb anb CnlargeiJ 



NEW YORK AND LONDON 

D. APPLETON & CO. 
1914 



Ml 



COPTBIGHT, 1894, 1897, 1903, 1906, 1909, 1912, 1914, bt 
D. APPLETON AND COMPANY 



Printed in the United States of America 

MAR "6 1914 r 

©CI.A3 62 79 5 



TO 
THE YOUNG MOTHERS OF AMERICA, 

TOWAKD THE SOLUTION OF WHOSE PROBLEMS 
THESE PAGES HAVE BEEN DEVOTED, 

THIS WORK 

IS RESPECTFULLY DEDICATED 

BY THE AUTHOR. 



/ 



PKEFACE TO THE SEVENTH EDITION 



The constant use of the Catechism as a manual 
for nursery maids has shown the need of fuller treat- 
ment of several subjects than was given in the earlier 
editions. An attempt has been made to meet the 
needs of mothers and nurses outside of institutions 
who have made the book a nursery guide, especially 
in matters relating to older children. 

The author's aim has been not to alarm the mother 
by acquainting her with all the possible diseases and 
accidents which may befall her child, but to open 
her eyes to matters which are her direct and chief 
concern. 

It is, therefore, the needs of the well child, not 
the sick one, which have been considered. The well 
child must, in most cases, be left to the care of the 
mother or nurse for whose guidance and assistance 
these pages are intended. Eor directions in matters 
of illness, however, no mother or nurse should de- 

7 



8 THE CARE AND FEEDING OF CHILDREN 

pend upon any manual, but upon the advice of a 
physician. 

It is hoped that the mothers and nurses who have 
found the earlier editions of the Catechism helpful 
in the solution of some of their nursery problems 
will find even greater assistance from the present 
volume. 

New Yoek, 1914 



CONTENTS 



THE CARE OF CHILDREN 

PAGE 

Bathing 15 

Genital organs 16 

Eyes 17 

Mouth 18 

Skin 19 

Clothing 21 

Napkins 24 

Nursery 25 

Airing 27 

Weight, growth, and development 31 

Dentition 37 



n 

INFANT FEEDING 

Niu'sing 44 

Weaning from the breast 53 

Weaning from the bottle 54 

Artificial feeding 57 

Selection and care of milk used for infant feeding . . 57 

Modification of cow's milk 62 

Top milk, 67; cream, 69. 

9 



10 THE CARE AND FEEDING OF CHILDREN 

PAGE 

Food for healthy infants 70 

Formulas from 7-per-cent milk, 72; formulas from 
whole milk, 78. 
General rules for guidance in feeding . . . . .81 
How to begin, 81; increasing the food, 82; reducing 
the food, 85. 

Addition of other foods to milk 86 

Use of beef juice, 87; white of egg, 87; orange 
juice, 88. 

Substitutes for fresh milk 88 

Overfeeding 90 

Loss of appetite ......... 92 

Changes in food required by special symptoms ... 93 
Vomiting, 92; coHc, 95; constipation, 96; hot weather, 
97; use of condensed milk, 99; acute illness, 100; diar- 
rhoea, 101. 

Common mistakes in infant feeding 102 

Preparation of milk at home 104 

Directions for feeding 107 

Intervals of feeding . 109 

Schedule of quantities and intervals for first year . .110 

Regularity in feeding Ill 

Sterilized milk 112 

Pasteurized milk . 115 

Modified milk from the milk laboratories . . . .117 

Peptonized milk ......... 117 

Condensed milk ^ . . . 118 

Buttermilk * . . .120 

Caseinmilk 121 

Feeding during the second year 122 

Schedule for twelfth to fifteenth month .... 123 
Schedule for fourteenth to eighteenth month . . .125 

Schedule for eighteenth to twenty-fourth month . . . 126 

Feeding during the third year 128 



CONTENTS 11 



^ III 
THE DIET OF OLDER CHILDREN 

PAGE 

Milk and cream 134 

Eggs 135 

Meats and fish . . . 136 

Vegetables 137 

Cereals 139 

Broths and soups . . . . . . . .140 

Bread, crackers, and cakes 141 

Desserts 141 

Fruits 143 

Indigestion in older children 145 

Acute indigestion, 145; chronic indigestion, 147. 
General rules to be observed in feeding . . . .149 

Food formulas 152 

Beef juice, 152; mutton broth, 153; chicken, veal, and 
beef broths, 153; scraped beef or meat pulp, 154; 
junket curds, and whey, 154; barley water, 154; bar- 
ley jelly, 155; rice, wheat, oat water, 155; oat, wheat, 
rice jelly, 156; albumin water, 156; hme-water, 156; 
dried bread, 157; coddled egg, 157. 

MISCELLANEOUS 

Bowels . 161 

Sleep .163 

Causes of disturbed sleep 165 

Exercise . 167 

Cry .168 

Lifting children 170 



12 THE CARE AND FEEDING OF CHILDREN 

PAGE 

Temperature 171 

Nervousness ......... 173 

Playing with babies 173 

Toys . . .174 

Kissing . 176 

Convulsions 176 

Foreign bodies swallowed .177 

Foreign bodies in the ear 179 

Foreign bodies in the nose 179 

CoHc 179 

Earache 18Q 

Croup 181 

Contagious diseases .182 

Measles, 182; German measles, 183; scarlet fever, 
183; whooping cough, 184; chicken pox, 184; diph- 
theria, 184; mumps, 185. 

Treatment for commencing illness 186 

Nursery training to help the doctor 187 

Scurvy 187 

Constipation 189 

Diarrhoea 191 

Bad habits 192 

Vaccination . 196 

Adenoids 197 

Enlarged tonsils 199 

Weight charts 201, 202 

Index 205 



PART I 
THE CARE OF CHILDREN 



THE CARE AND FEEDING OF 
CHILDREN 



THE CARE OF CHILDREN 



BATHIl^a 



At what age may a child he given a full tub hath? 
"Usually when ten days old; it should not be 
given before the cord has come off. 

How should the hath he given? 

It should not be given sooner than one hour after 
feeding. The room should be warm; if possible 
there should be an open fire. The head and face 
should first be washed and dried; then the body 
should be soaped and the infant placed in the tub 
with its body well supported by the hand of the 
nurse. The bath should be given quickly, and the 
body dried rapidly with a soft towel, but with very 
little rubbing. 

At what temperature should the hath he given? 
For the first few weeks at 100 '^ F. ; later, dur- 



15 



16 THE CAEE AND FEEDING OF CHILDEEN 

ing early infancy, at 98° F. ; after six months, at 
95° F.; during the second year, from 85° to 90° F. 

With what should the hath he given? 

Soft sponges are useful for bathing the body, 
limbs and scalp. There should be a separate wash- 
cloth for the face and another for the buttocks. 

What are the ohjections to hath sponges? 

When used frequently, they become very dirty 
and are liable to cause infection of the eyes, mouth, 
or genital organs. 

Under what circumstances should the daily tub 
hath he omitted? 

In the case of very feeble or delicate infants on 
account of the exposure and fatigue, and in all forms 
of acute illness except by direction of the physician. 
In eczema and many other forms of skin disease 
much harm is often done by bathing with soap and 
water, or even with water alone. 

GEITITAL OEGAITS 

How should the genital organs of a female child 
he cleansed? 

Best with fresh absorbent cotton and tepid water, 
or a solution of boric acid, two teaspoonfuls to the 
pint. This should be done carefully at least once a 



EYES 17 

day. If any discliarge is present, the boric-acid so- 
lution should invariably be used twice a day. Great 
care is necessary at all times to prevent infection 
v\^hich often arises from soiled napkins. 

How should the genital organs of a male child 
he cleansed? 

In infancy and early childhood the foreskin 
should be pushed completely back at least twice a 
week while the child is in his bath, and the parts 
thus exposed washed gently with absorbent cotton 
and water, afterwards drawn forward again. 

If the foreskin is tightly adherent and cannot 
readily be pushed back, the physician's attention 
should be called to it. The nurse or mother should 
not attempt forcible stretching. 

When is circumcision advisable? 

Usually, when the foreskin is very long and so 
tight that it cannot be pushed back without force; 
always, when this condition is accompanied by evi- 
dences of local irritation or difficulty in passing 
water. 

EYES 

How should the eyes of a little hahy he cleansed? 
With a piece of soft linen or absorbent cotton 



18 THE CAEE AND FEEDING OF CHILDREN 

and a lukewarm solution of salt or boric acid, — one 
even teaspoonful to one pint of water. 

If pus appears in the eyes, what should he 
done? 

They should be cleansed every hour with a solu- 
tion of boric acid (ten grains to one ounce of water). 
If the lids stick together, a little vaseline from a tube 
should be rubbed upon them at night. If the trouble 
is slight, this treatment will control it ; if it is severe, 
a physician should be called immediately, as delay 
may result in loss of eyesight. 

MOUTH 

Sow is an infant's mouth to he cleansed? 

An excellent method is by the use of a swab made 
T3y twisting a bit of absorbent cotton upon a wooden 
toothpick. With this the folds between the gums and 
lips and cheeks may be gently and carefully cleansed 
twice a day unless the mouth is sore. It is not neces- 
sary after every feeding. The finger of the nurse, 
often employed, is too large and liable to injure the 
delicate mucous membrane. 

What is sprue f 

It appears on the lips and inside the cheeks like 
little white threads or flakes. It is also called thrush. 



SKIN 19 

In bad cases it may cover the tongue and the whole 
of the inside of the mouth. 

How should a mouth be cleansed when there is 
sprue ? 

It should be washed carefully after every feeding 
or nursing with a solution of borax or bicarbonate of 
soda (baking soda), one even teaspoonful to three 
ounces of water, and four times a day the boric-acid 
solution mentioned on previous page should be used. 



SKIK 

How should the infant's shin he cared for to pre- 
vent chafing? 

First, not too much nor too strong soap should be 
used ; secondly, careful rinsing of the body ; thirdly, 
not too vigorous rubbing, either during or after the 
bath; fourthly, tne use of dusting powder in all the 
folds of the skin, — under the arms, behind the ears, 
about the neck, in the groin, etc. This is of the 
utmost importance in very fat infants. 

If the sJcin is very sensitive and chafing easily 
produced^ what should he done ? 

No soap should be used, but bran or salt baths 
given instead. 



20 THE CARE AND FEEDING OF CHILDREN 

How should a hran bath he prepared? 

One pint of wheat bran sliould be placed in a bag 
of coarse mnslin or cbeese-clothj and this put in the 
bath water. It should then be squeezed for five min- 
utes, until the water resembles a thin porridge. 

Hoiv should a salt hath he prepared? 
A teacupful of common salt or sea salt should be 
used to each two gallons of water. 

How should the huttoclcs he cared for? 

This is the most common place for chafing, as the 
parts are so frequently wet and soiled; hence the 
utmost pains should be taken that all napkins be re- 
moved as soon as they are wet or soiled, and the parts 
kept scrupulously clean and well powdered. 

If the parts have hecorae chafed, what should he 
done? 

Only bran and salt baths should be used, and in 
very severe cases even these may have to be omitted 
for a day or two. The parts may be cleansed with 
sweet oil and a little absorbent cotton, and the skin 
kept covered with a dusting powder composed of 
starch two parts, boric acid one part. 

What is pricMy heat, and how is it produced? 

It consists of fine red pimples, and is usually 
caused by excessive perspiration and the irritation of 
flannel underclothing. 



CLOTHING 21 



How should it be treated? 

Lighter clotliing should be used ; muslin or linen 
should be put next to the skin; the entire body 
should be sponged frequently with equal parts of 
vinegar and water, and plenty of the starch and 
boric-acid powder mentioned should be used. 



CLOTHIiq-G 

What are the most essential things in the clothing 
of infants? 

That the chest should be covered with soft flannel, 
the limbs well protected but not confined, and the 
abdomen supported by a broad flannel band, which 
should be snug but not too tight. It is important 
that the clothing should flt the body. If it is too 
tight it interferes with the free movements of the 
chest in breathing, and by pressing upon the stomach 
sometimes causes the infant to vomit soon after swal- 
lowing its food. If the clothing is too loose it is 
soon thrown into deep folds or bunches, which cause 
much discomfort. IvTo pins should be used, but, in- 
stead, all bands about the body should be basted. 
The petticoats should be supported by shoulder 
straps. 



22 THE CAKE AND FEEDING OF CHILDREN 



How should the infant he held during dressing 
and undressing? 

Nothing is more awkward than to attempt to 
dress a young baby in a sitting posture. It should 
lie upon the nurse's lap until quite old enough to 
sit alone J the clothing being drawn over the child's 
feetj not slipped over the head. 

Of what use is the hand? 

It protects the abdomen, but its most important 
use is to support the abdominal walls in very young 
infants, and in this way to prevent the occurrence of 
rupture. 

How long is this hand required? 

The snug flannel band, not usually more than 
three or four months. In healthy infants with plenty 
of fat this may then be replaced by the knitted band, 
which may be worn up to eighteen months. The 
band is an important article of dress in the case of 
thin infants whose abdominal organs are not suffi- 
ciently protected by fat. With such, or with those 
prone to diarrhoea, it is often advisable to continue 
the band until the third or fourth year. 

What changes are to he made in the clothing of 
infants in the summer? 

Only the thinnest gauze flannel undershirts 
should be worn, and changes in temperature should 



CLOTHING 23 



be met by changes in the outer garments. The great- 
est care should be taken that children are not kept 
too hot in the middle of the day, while extra wraps 
should be used morning and evening, especially at 
the seashore or in the mountains. 

Should older children he allowed to go with their 
legs hare? 

If strong and well there is no objection to this in 
hot weather. In cold weather, however, it is doubt- 
ful if any children are benefited by it, particularly 
in a changeable climate like that of New York. 
Many delicate children are certainly injured by such 
attempts at hardening. 

What sort of underclothing should he worn dur- 
ing cold weather? 

ITever the heaviest weight, even in winter. Four 
grades are usually sold, the next to the heaviest being 
thick enough for any child. 

Do little children require as heavy flannels as 
older people? 

Not as a rule. They usually live in a warm 
nursery; their circulation is active; and they always 
perspire easily during their play. When they go out 
of doors, the addition of coats and leggings renders 
thick flannels unnecessary. 



24 THE CAEE AND FEEDING OF CHILDKEN 

Are not many little children clothed too thinly 
for the ordinary house? 

Very few. The almost invariable mistake made 
in city homes is that of excessive clothing and too 
warm rooms. These two things are among the most 
frequent reasons for their taking cold so easily. 



iq^APKINS 

How should napTcins he tahen care of? 

They should be immediately removed from the 
nursery when soiled or wet. Soiled napkins should 
be kept in a receptacle with a tight cover, and washed 
as soon as possible. 

Should napkins which have been only ivet he 
■used a second time ivithout vjashing? 

It is no doubt better to use only fresh napkins, 
but there is no serious objection to using them twice 
unless there is chafing of the skin. Clean napkins, 
changed as soon as wet or soiled, are of much im- 
portance in keeping the skin healthy. 

^Yhat are the important things to he ohserved in 
washing napTcins? 

Soiled napkins should not be allowed to dry, but 
should receive a rough washing at once; they should 



NUESERY 25 

then be kept in soak in plain water until a conve- 
nient time for washing, — at least once every day, — 
when they should be washed in hot suds and boiled 
at least fifteen minutes. Afterward they should be 
very thoroughly rinsed or they may irritate the skin, 
and ironed without starch or blueing. They should 
never be used when damp. 



KTTESERY 

What are the essentials in a good nursery? 

The furnishings should be very simple, and un- 
necessary hangings and upholstered furniture should 
be excluded. As large a room as possible should be 
selected — one that is well ventilated, and always one 
in which the sun shines at some part of the day, as 
it should be remembered that an average child spends 
here at least three fourths of its time during the first 
year. The nursery should have dark shades at the 
windows, but no extra curtains; about the baby's 
crib nothing but what can be washed should be al- 
lowed. The air should be kept as fresh and as pure 
as possible. There should be no plumbing, no dry- 
ing of napkins or clothes, no cooking of food, and 
no gas burning at night. A small wax night-light 
answers every purpose. 



26 THE CAEE AND FEEDING OF CHILDREN 

How should a nursery he heated? 

Best by an open fire ; next to this by a Franklin 
stove. The ordinary hot-air furnace of cities has 
many objections, but it is not so bad as steam heat 
from a radiator in the room. A gas stove is even 
v^orse than this, and should never be used, except, 
perhaps, for a fev7 minutes during the morning 
bath. 

At what temperature should a nursery he Tcept 
during the day? 

Best, 64° to 68° F., measured by a thermometer 
hanging three feet from the floor. The tempera- 
ture should not be allowed to go above 70° F. 

At what temperature during the night? 

During the first tvro or three months, not below 
65° F. After three months the temperature may go 
as low as 55° F. After the first year it may be 50° 
or even 45° F. 

At what age may the window he left open at 
night ? 

Usually after the third month, except when the 
outside temperature is below freezing point. 

How often should the nursery he aired? 

At least twice a day — in the morning after the 
child's bath, and again in the evening before the 
child is put to bed for the night. This should be 



AIEING 27 



done thoroughly, and the child should be removed 
meanwhile to another apartment. It is well to air 
the nursery whenever the child is out of the room. 

What symptoms are seen in a child who is Jcept 
in too hot a room? 

It becomes pale, loses appetite, shows symptoms 
of indigestion^ occasionally vomits, stops gaining in 
weight, perspires very much, and takes cold easily 
because of this and also because of the great differ- 
ence between the indoor and outdoor temperatures. 
Its condition may be such as to lead one to suspect 
very serious illness. 



AIEING 

How early may airing indoors he commenced and 
how long may it he continued? 

Airing in the room may be begun with a strong, 
healthy child, even in cold weather, when he is one 
month old, at first for only fifteen or twenty min- 
utes at a time. This period may be gradually length- 
ened by ten or fifteen minutes each day until it is 
four or five hours. This airing may be continued in 
almost all kinds of weather. 



28 THE CAEE AND FEEDING OF CHILDREN 

Is there not great danger of a young baby's tak- 
ing cold when aired in this manner? 

IsTot if the period is at first short and the baby 
accustomed to it gradually. Instead of rendering the 
child liable to take cold, it is the best means of pre- 
venting colds. 

now should such an airing be given? 

The child should be dressed with bonnet and light 
coat as if for the street and placed in its crib or car- 
riage which should stand a few feet from the win- 
dow. All the windows are then thrown wide open, 
but the doors closed to prevent draughts. Screens 
are unnecessary. 

At what age may a child go out of doors? 

In summer, when one week old; in spring and 
fall, usually at about one month; in winter, when 
about three months old, but only on pleasant days, 
being kept in the sun and out of the wind. 

What are the best hours for airing out of doors? 

In summer and early autumn a child may be out 
almost any time between seven in the morning and 
sunset; in winter and early spring, a young child 
only between 10 or 11 a. m. and 3 p. m.^ although 
this depends somewhat upon the climate. In K'ew 



AIRING 29 



York and along the Atlantic coast the early morn- 
ings are apt to be damp and the afternoons raw and 
cloudy. 

On what kind of days should a haby not go out? 

In sharp winds, when the ground is covered with 
melting snow, and when it is extremely cold. A child 
under four months old should not usually go out if 
the thermometer is below freezing point; nor one 
under eight months old if it is below 20° F. 

Exceptions to all the above statements are to be 
made in the case of very small and especially deli- 
cate infants. Though they should have fresh air in 
abundance, they should be much more carefully pro- 
tected against cold. 

What are the most important things to he attended 
to when the child is out in its carriage ? 

To see that the wind never blows in its face, that 
. its feet are properly covered and warm, and that the 
sun is never allowed to shine directly into its eyes 
when the child is either asleep or awake. 

Of what advantage to the child is going out? 

Fresh air is required to renew and purify the 
blood, and this is just as necessary for health and 
growth as proper food. 



30 THE CAEE AND FEEDING OF CHILDREN 

What are the effects produced in infants hy fresh 
air? 

The appetite is improved^ the digestion is better^ 
the cheeks become red, and all signs of health are 
seen* 

Is there any advantage in having a child taJce 
its airing during the first five or six months in the 
nurse's arms? 

ITone whatever. A child can be made much more 
comfortable in a baby carriage^ and can be equally 
well protected against exposure by blankets and the 
carriage umbrella. 

What are the objections to an infant's sleeping 
out of doors? 

There are no real objections. It is not true that 
infants take cold more easily when asleep than awake, 
while it is almost invariably the case that those who 
sleep out of doors are stronger children and less prone 
to take cold than others. 

What can he done for older children who take 
cold upon the slightest provocation? 

They should be kept in cool rooms, especially 
when asleep. They should not wear such heavy 
clothing that they are in a perspiration much of 
the time. Every morning the body, particularly the 



WEIGHT, GEOWTH, AND DEVELOPMENT 31 

neck, chest, shoulders and back, should be sponged 
with cold water (50^ to 60^ F.). 

How should this cold sponge hath he given? 

The child should stand in a tub containing a 
little warm water, and a large bath sponge filled with 
cold water should be squeezed two or three times 
over chest and shoulders. For best effects this sponge 
bath should be very cold and very short. It should 
be followed by a vigorous rubbing with a towel until 
the skin is quite red. This may be begun at three 
years, and often at two years. For infants a little 
higher temperature (65° to 70° F.) may be used. 

s 

WEIGHT^ GEOWTH^ Al^D DEVELOPMEITT 

Of what importance is the weight of the child? 

IvTothing else tells so accurately how well it is 
thriving. 

During the first year a record of the weight is 
almost indispensable; throughout childhood it is of 
much interest and is the best guide to the physical 
condition. It will well repay any mother or nurse 
to keep such a record. 

How frequently should a child he lueighed? 
Every week during the first six months, and at 
least once in two weeks during the last six months 



32 THE CAKE AND FEEDING OP CHILDEEN 

of the first year. During the second year a child 
should be weighed at least once a month. 

How rapidly should an infant gain in weight 
during the first yearf 

There is usually a loss during the first week of 
from four to eight ounces ; after this a healthy child 
should gain from four to eight ounces a week up to 
about the sixth month. From six to twelve months 
the gain is less^ usually from two to four ounces a 
week. 

Is it to he expected that bottle-fed infants will 
gain as rapidly as those luho are nursed? 

They seldom do so during the first month ; after 
that time under favourable circumstances the gain 
is usually quite as regular, and during the latter 
half of the first year it is likely to be more con- 
tinuous than in a nursing infant, because the latter 
usually loses weight at the time of weaning. 

Why do they not gain so rapidly at first ? 

It takes a few weeks for the stomach to become 
accustomed to cow's milk, and until this is accom- 
plished it is necessary to make the milk very weak 
oz the child's digestion will be upset. 



WEIGHT, GEOWTH, AND DEVELOPMENT 33 

For a child of average weight at hirth (seven 
to seven and a half pounds) what should he the 
weight at the different periods during the first 
year? 

At three months it should be twelve to thirteen 
pounds ; at six months^ fifteen to sixteen pounds ; at 
nine months, seventeen to eighteen pounds; at one 
year, tv^enty to twenty-two pounds. At five months 
an average healthy child has doubled its weight, and 
at twelve months it has nearly trebled its weight. 

Do all healthy infants gain steadily in weight 
during the first year? 

As a rule they do; yet it is seldom the case that 
one gains every week for the entire year. With most 
infants there are from time to time periods of a few 
weeks in which no gain is made. These are more 
often seen from the seventh to the tenth month and 
frequently occur when the child is cutting teeth, 
sometimes during very hot weather. 

75 it true that every infant who gains rapidly in 
weight is thriving normally? 

Not invariably. Some who are fed upon pre- 
pared infant foods increase rapidly in weight but . 
not in strength, nor in their development in other 
respects. 



»34 THE CARE AND FEEDING OF CHILDREN 

Is the tveight of as much value in the second year 
as a guide to the child's condition? 

After the first year, the gain in weight is seldom 
continuous; there are many interruptions, some de- 
pend on season, and others often occur without ap- 
parent cause. 

At what age should the fontanel close? 

The average is about eighteen months. It seldom 
closes earlier than fourteen months, and it should 
not be open at two years. 

At vjhat age should a child hold up its head? 

As a rule during the fourth month, and often 
during the third month, the head can be held erect 
when the body is supported. 

When does an infant first laugh aloud? 
Usually from the third to the fifth month. 

When does it begin to reach for toys and handle 
them? 

Usually from the fifth to the seventh month. 

At what age should a child he ahle to sit and to 
stand alone? 

At seven or eight months a healthy child is usu- 
ally able to sit erect and support the body. During 
the ninth and tenth months are usually seen the first 
attempts to bear the weight upon the feet, and at 



WEIGHT, GROWTH, AND DEVELOPMENT 35 

eleven or twelve months most children can stand with, 
assistance. 

When should a child walk alone f 

The first attempts are generally seen in the 
twelfth or thirteenth month. At fifteen or sixteen 
months the average child is able to run alone. 

What conditions postpone these events? 

Prematurity, a very delicate constitution, any 
severe or prolonged illness, and especially chronic 
disturbances of digestion making feeding difficult. 
A common cause of late sitting, standing, or walk- 
ing is rickets. 

Should a child he urged to walk? 

IsTever; he is usually quite willing to do so as 
soon as his muscles and bones are strong enough. 
!N"one of the contrivances for teaching children to 
walk are to be advised. 

When do children hegin to talk ? 

Generally at one year a child can say "papa'^ 
and ^^mamma'' or other single words. At the end 
of the second year the average child is able to put 
words together in short sentences. 

If at two years the child makes no attempt to 
speak, what should he suspected? 

Either that the child is a deaf-mute or that it is 



36 THE CAEE AND FEEDING OF CHILDKEK 

mentally deficient, although this is occasionally seen 
in children who are in other respects quite normal. 



Table showing the Average Weighty Height, and Circuni' 
ference of Head and Chest of Boys^ 

At birth Weight 73^ pounds 

Height 203^ inches. 

Chest 13H " 

Head 14 

One year Weight 21 pounds. 

Height 29 inches. 

Chest 18 

Head 18 

Two years Weight 27 pounds. 

Height 32 inches. 

Chest 19 

Head 19 

Three years Weight 32 pounds. 

Height 35 inches 

Chest 20 

Head 19K " 

Four years Weight 36 pounds. 

Height 38 inches. 

Chest 20M '' 

Head.... 19% '' 

Five years Weight 41 pounds. 

Height 413^ inches. 

Chest 21 J^ " 

Head 2034 " 

^ Weights for the first four years are without clothes. 

The weight of girls is on the average about one pound less 
than boys. They are about the same in height. 

Charts showing weight curve for the first year, and from one 
year to fourteen years are given at the end of this book. 



DENTITION 37 



Six years Weight 45 pounds. 

Height 44 inches. 

Chest 23 

Seven years Weight. 493^2 pounds. 

Height 46 inches. 

Chest 233^ '' 

Eight years Weight 543^ pounds. 

Height 48 inches. 

Chest 243^ '' 

Nine years Weight 60 pounds. 

Height 50 inches. 

Chest 25 

Ten years Weight 663^ pounds. 

Height 52 inches. 

Chest 26 

The above weights are with ordinary house clothes. 



DEI^TITION" 

How many teeth are there in the first set? 
Twenty. 

What is the time of their appearance ? 

The tv70 central lower teeth are usually the first 
to appear, and come from the fifth to the ninth 
month; next are the four upper central teeth, which 
come from the eighth to the twelfth month. The 
other two lower central teeth and the four front 
double teeth come from the twelfth to the eighteenth 
month. Then follow the four canine teeth, the two 
upper ones being knovTU as the '^eje teeth/^ and the 



38 THE CABE AND FEEDING OF CHILDKEN 

two lower as the "stomach teeth''; they generally 
come between the eighteenth and the twenty-fourth 
month. The four back double teeth, which complete 
the first set, come between the twenty-fourth and 
thirtieth month. 

At one year a child usually has six teeth. 

At one and a half years, twelve teeth. 

At two years, sixteen teeth. 

At two and a half years, twenty teeth. 

What are the causes of variation? 

The time of appearance of the teeth varies in 
different families; in some they come very early, 
in others much later. The teeth may come late as 
a result of prolonged illness and also from rickets. 

What symptoms are commonly seen ivith teeth- 
ing? 

In ^healthy children there is very often fretful- 
ness and poor sleep for two or three nights; there 
may be loss of appetite, so that only one half the 
usual amount of food is taken; there is salivation 
or drooling, and often slight fever; there may be 
some symptoms of indigestion, such as vomiting or 
the appearance of undigested food in the stools. In 
delicate children all these symptoms may be much 
more severe. 



DENTITION 3^ 



How long do these sympioms last? 
Usually only three or four days; but there may 
be no gain in weight for two or three weeks. 

What is the cause of most of the other symptoms 
attributed to teething? 

Nearly all of them come from indigestion due to^ 
bad feeding. 



PAET II 
INFANT FEEDING 



11 

INFANT FEEDING 

'What is the best infant food? 
Mother's milk. 

Of what is mother s milk composed? 
Thirteen parts solids and eighty-seven water. 

What are the solids? 

Fat, sugar, proteids, and salts. 

What is the fat? 
The cream. 

What is the sugar? 

It is lactose, or milk sugar. 

What are the proteids? 
The curd of the milk. 

Are all these elements necessary? 
Yes; we cannot expect to rear a healthy infant 
unless they are all in his food. 

Of what use is the fat? 

It is needed for the growth of bones, nerves, the 
fat of the body, and the production of heat. 

43 



44 THE CAKE AND FEEDING OF CHILDEEN 

Of what use is the sugar? 

It is needed for the prodnction of heat, and to 
make fat in the body. 

Of what use are the proteids? 

They are needed for the growth of the body cells, 
such as those of the blood, the organs, and the mus- 
cles. 

Of ivhat use are the salts f 
Particularly for the growth of bone. 

Of what use is the water? 

By means of the water the food is kept in a state 
of minute subdivision or in solution, so that the deli- 
cate organs of the infant can digest it. It is also 
necessary to enable the body to get rid of its waste. 

NXJESING 

Why should mothers nurse their children? 

First, because there is no perfect substitute for 
good breast-feeding. Secondly, statistics show that 
the mortality of bottle-fed infants during the first 
year is fully three times as great as that of those 
who are breast-fed. 

At what period is nursing of greatest importance? 
During the first three or four months, to give the 



NUESING 45 



child a proper start. At this time of life the mor- 
tality is highest and artificial feeding is most difficult. 

When should maternal nursing not be attempted? 

If the mother has or has had tuberculosis or any 
other serious chronic disease, or is herself in very 
delicate health, she should not try. She is likely soon 
to fail in nourishing her child, and the attempt may 
do herself much harm as well as injure the child. 

How often should infants he nursed during the 
first two days of life? 

Usually only four or five times daily, since there 
is very little milk secreted at this time. 

When does the milk come in abundance? 
Usually on the third day, sometimes not until 
the fourth or fifth day. 

Should the infant he fed anything additional 
during the first two days? 

Usually not; if much food were necessary, we 
may be sure Nature would have provided it. Water, 
however, should be given regularly. 

How frequently should an infant he nursed dur- 
ing the first week? 

After the third day, every two hours during the 
day and twice during the night. The frequency 



46 



THE CARE AND FEEDING OF CHILDEEN 



during the entire first year is given in the following 
table : 



Period. 


Nursings in 
24 hours. 


Interval by day. 


Night nursings 

(10 P.M. to 6 A.M.) 


1st and 2nd day. . . . 

3 days to 2 weeks . . . 
2 weeks to 4 months 

4 to 9 months 

9 to 12 months 


4 
8 
7 
6 
5 


6 hours. 
2>^ " 
3 " 

3 " 

4 " 


1 
1 
1 






How long should the child he Tcept at the h7xasi 

for one nursing? 

]Srot over twenty minutes. 

Should the child take both breasts at one nursing? 
If the milk is very abundant one breast may be 
sufficient, otherwise both breasts may be taken. 

What are the important things to be attended to 
in nursing? 

First, regularity; it is just as important as in 
the case of bottle-feeding. Secondly, the nipples 
should be kept clean by being washed after every 
nursing. 

What should be the diet of a nursing mother? 

She should have a simple but generous diet with 
plenty of fluids; three regular meals may be given, 
and gruel, milk, or cocoa at bed-time and sometimes 
between meals. She may take eggs, cereals, most 



NUESING 47 



soups, and nearly all vegetables, avoiding sonr fruits, 
salads, pastry, and most desserts. Meat should not 
be taken more than twice daily, and in many cases 
but once. She should take but little tea or coffee, 
and ordinarily no wine or beer. 

Are fruits likely to disturb a nursing infant? 
Sour fruits in some cases may do so, but sweet 
fruits and most cooked fruits are useful. 

What else is important in the life of the nursing 
mother? 

She should lead a simple natural life; should 
have regular out-of-door exercise, preferably walking 
or driving, as soon after her confinement as her con- 
dition will permit. She should have regular move- 
ments from the bowels daily. She should be as free 
as possible from unnecessary cares and worry; her 
rest at night should be disturbed as little as possible ; 
she should go to bed early and lie down for at least 
one hour in the middle of the day. 

Does the nervous condition of the mother affect 
the milk? 

Very much more than her diet; worry, anxiety, 
fatigue, loss of sleep, household cares, social dissipa- 
tion, etc., have more than anything else to do with 
the failure of the modern mother as a nurse. Uncon- 
trolled emotions, grief, excitement, fright, passion. 



48 THE CAKE AND FEEDING OF CHILDKEN 

may cause milk to disagree with the child ; at times 
they may excite acute illness^ and at other times they 
may cause a sudden and complete disappearance of 
the milk. 

Does menstruation ajfect the milTc? 

In nearly all cases the quantity of milk is less- 
ened so that the infant is not satisfied and may gain 
less in weight or not at all. In many cases the qual- 
ity of the milk is also affected to such a degree as to 
cause slight disturbances of digestion, like restless- 
nesSj colic, or some derangement of the bowels. In 
a few, attacks of acute indigestion are excited. 

Is the return of menstruation u^ reason for stop- 
ping nursing? 

Not invariably; as a rule both functions do not 
go on together. But if the child is gaining regu- 
larly in weight between the periods, nursing may be 
continued indefinitely, although it may be well to 
feed the infant wholly or in part during the first 
day or two that the mother is unwell. 

What symptoms indicate that a nursing infant is 
well nourished? 

The child has good color, sleeps two or three 
hours after nursing, or, if awake, is quiet, good- 
natured, and apparently comfortable. It has normal 
movements of the bowels and gains weight steadily. 



NUKSING 49 



What symptoms indicate a scanty milk supply 
and that an infant who is nursing is not properly 
nourished? 

It does not gain and may even lose in weight. 
It no longer exhibits its usual energy and playful- 
ness, but is either listless and indifferent or cross, 
fretful and irritable, and is apt to sleep poorly. It 
grows pale and anaemic and its tissues become soft 
and flabby. AVhen the milk is scanty it will often 
nurse a long time at the breasts, sometimes three 
quarters of an hour, before stopping'. At other times 
it may take the breast for a moment only, and then 
turn away in apparent disgust. The only sure way of 
telling how much ^ilk a child is getting is to weigh it 
before and after nursing, four or five times a day; 
the child need not be undressed for this purpose. 

What should be done in such cases? 

This depends upon the severity of the symptoms 
and how long they have lasted. If the child has 
made no gain for several weeks, or is losing weight, 
immediate weaning will probably be necessary; in 
any case, other food in addition to the breast milk 
should be given at once. One may begin by alter- 
nating the nursing and the bottle-feeding and in- 
crease the number of bottle-feedings as may be in- 
dicated by the results, or one may nurse as before 
and give a smaller bottle-feeding after the child has 



50 THE CARE AND FEEDING OF CHILDREN 

taken the breast. A scanty secretion is likely 
to be still further reduced by lessening the number 
of nursings, while more frequent nursings tend to 
increase the flow. 

Is there any objection to a hahy being partly 
nursed and partly fed? 

ISTone whatever; it is often better from the out- 
set to feed the baby during the night, in order not 
to disturb the mother's rest. If the mother has only 
milk enough for two or three nursings a day, this 
should be continued so long as her milk agrees with 
the baby. Even a small amount of good breast milk 
greatly improves a child's nutrition. 

What symptoms indicate that the mother s milk 
disagrees with the child? 

This should be carefully distinguished from the 
more common condition of hunger due to scanty 
milk. If the milk disagrees, the child suffers from 
almost constant discomfort ; sleeps little and then rest- 
lessly, cries a great deal, belches gas from the stom- 
ach, and passes much by the bowels, or if not passed, 
the gas accumulates and causes abdominal distention 
and colicky pain. There may be vomiting, but more 
often the trouble is intestinal. Sometimes the bowels 
are constipated, but usually the movements are fre- 
quent, loose, green, contain mucus and are passed 
with much gas. 



NURSING 51 



What should be done under these circumstances? 

If the symptoms have persisted for two or three 
weeks and the child is not gaining in weight, there 
is little chance of improvement, and the child should 
be taken from the breast at once. If there is some 
gain in weight, one may try for a little longer, en- 
deavouring to improve the mother's milk by rest, 
fresh air, careful diet, etc. However, one should 
realize that the trouble is nearly always with the 
milk, not with the child. 

What changes should he made if a nursing infant 
hahitually vomits? 

If this occurs soon after nursing, the infant has 
usually taken too much and the time of nursing 
should be shortened, or one breast may be given 
instead of two; the nursing should also be inter- 
rupted by occasional rests, so that the milk is not 
taken too fast. If the vomiting occurs some time 
after nursing and is repeated, it is a sign of indiges- 
tion ; often the milk is too rich in fat. The intervals 
between nursings should be lengthened to three and 
a half or even four hours; the breast milk may be 
diluted by giving one or two tablespoonfuls of plain 
boiled water, lime-water, or barley-water, five or ten 
minutes before nursing; the mother should eat less 
hearty food, especially less meat. If the child is 



52 THE CAKE AOT) FEEDING OF CHILDEEN 

thriving and gaining regularly in weight the vomit- 
ing will in most cases gradually improve with the 
changes in regime mentioned ; but if the child is los- 
ing weight weaning is usually advisable. 

What should he done if the infant has frequent 
hahitual colic? 

The mother should take more out-of-door exer- 
cisCj eat less meat and seek to control her emotions ; 
all causes of worry should be removed. If the con- 
stipation which accompanies this condition is re- 
lieved, the colic will usually disappear also. It is 
often useful to increase the interval between feedings. 

Can constipation in a nursing infant he con- 
trolled through the mother s milk? 

Only to a limited extent. It is important that 
the mother's bowels be regular and her digestion 
good. An increase in the meat and milk of her diet 
is sometimes beneficial. (See pages 162 and 189.) 

What should he done when a nursing infant re- 
fuses to take the hreast? 

If this occurs suddenly in a child who has pre- 
viously nursed well, it is usually a symptom of acute 
illness; but if a child gradually takes less and less 
until finally it will not nurse at all, one may be cer- 
tain, if the child does not appear ill, that there is 
little or no milk in the breasts. 



WEANING 53 



WEAI^Il^G 

At what age should the child be weaned from 
the breast? 

Usually weaning should be begun at nine or ten 
months by substituting one feeding a day for one 
nursing, later two feedings, and thus gradually the 
child is to be taken from the breast altogether. 

What is the principal reason for weaning earlier? 

The most important one is that the child is not 
thriving — not gaining in weight nor progressing nor- 
mally in development. Serious illness of the mother,. 
or pregnancy, may make weaning necessary. 

At what age should the weaning be completed? 

Generally at one year. In summer it may some- 
times be advisable to nurse an infant a little longer 
rather than wean in warm weather; but even then 
the dangers of weaning are much less than those of 
continuing to nurse, as is so often done, after the 
milk has become very scanty and poor in quality. 

When should a child who is weaned from the 
breast be taught to drink from the cup, and when 
to take the bottle? 

If weaning is done as early as the eighth or ninth 
month it is better to give the bottle; if from the 
tenth to the twelfth month the infant should be 
taught to drink or be fed with a spoon. 



54 THE CAEE AND FEEDING OF CHILDKEN 

How may some difficulties in weaning he over- 
come ? 

By feeding every nursing infant once a day or 
by giving it water regularly from a feeding-bottle. 
It then becomes accustomed to the bottle. This is a 
matter of great convenience during the whole period 
of nursing when the mother or nurse may from 
necessity be away from the child for a few hours; 
when more f eedjngs are required at the time of wean- 
ing the child does not object. 

When should a child he weaned from the hottle? 

With children who are not ill, weaning from the 
bottle should invariably be begun at the end of the 
first year, and after a child is thirteen or fourteen 
months old the bottle should not be given except at 
the night feeding. 

Is there any ohjection to the child's talcing the 
hottle until it is two or three years old? 

There are no advantages and some serious objec- 
tions. Older children often become so attached to 
the bottle that only vdth the greatest difficulty can 
they be made to give it up. Frequently they will 
refuse all solid food, and will take nothing except 
from the bottle so long as it is given, and when 
finally, at three or four years, it is taken away, they 
will not touch milk during the rest of their child- 
hood. The difficulty is here that children form the 



WEANING 55 



^Tbottle habit." This habit is troublesomej "unneces- 
sary, and should by all means be prevented. An 
exclusive diet of milk for children of two or three 
years often results in anaemia and malnutrition. 

How should one train a child to do without the 
hottle? 

This is usually easy if it is begun at one year. 
The milk should be poured into a tiny glass or cup 
and little by little the child is taught to drink; at 
first only a small portion of the food is taken in this 
way, the balance being given from the bottle ; but in 
a few weeks the average infant learns to drink from a 
cup without difficulty, and all the food can be so given. 

If the child is two or more years old, the only 
effective means of weaning from the bottle is through 
hunger. The bottle should be taken away at once 
and entirely, and nothing allowed except milk from 
a cup until the child takes this willingly. Sometimes 
a child will go an entire day without food, occasion- 
ally as long as two days, but one should not be alarmed 
on this account and yield. This is a matter of the 
child's will, not his digestion, and once he has been 
conquered there is seldom any further trouble. As 
soon as a child has learned to drink his milk from a 
cup, cereals and other solid foods may gradually be 
added to the diet. The educational value of such 
training is not the least important consideration. 



56 THE CAEE AND FEEDING OF CHILDEEN 

Can a haby just weaned take cow's milk of the 
same proportions as one of the same age who has 
had coiu's milk from birth? 

Very rarely ; to give a baby wbo has had nothing 
but the breast from birth, plain cow's milk, or even 
that milk which a bottle-fed baby of the same age 
might take, is almost certain to cause indigestion. 
The change in the food is quite a marked one, and 
should be made gradually by beginning with a very 
weak milk and increasing its strength as the baby 
becomes accustomed to take cow's milk. 

What ivould he the proper proportions for an 
infant iveaned at four or five months? 

About the same as for a healthy bottle-fed infant 
of two months; the quantity of course should be 
larger. The food can in most cases be gradually 
increased so that in two or three weeks the usual 
strength for the age can be taken. 

What would he the proper proportions for an in- 
fant weaned at nine or ten months? 

About the same as for a bottle-fed infant at four 
or five months, to be increased as indicated above. 

Will not a child lose in weight when placed upon 
so low a diet? 

Very often it will do so for the first week or two, 
but after that will gain quite regularly; the acute 



THE SELECTION AND CARE OF MILK 57 

indigestion, however, which generally accompanies 
the use of stronger milk will, in most cases, cause a 
greater loss. 

ARTIFICIAL FEEDINa 

What foods contain all the elements present in 
mother s milhf 

The milk of other animals, — cow's milk being 
the only one which is available for general use. 

Is it not possible for infants to thrive upon other 
foods than those containing fresh milk? 

They may do so for a time, but never perma- 
nently. The* long-continued use of other foods as 
the sole diet is attended with great risk. 

What are the dangers of such foods? 

Frequently scurvy is produced, often rickets, and 
in other cases simply a condition of general malnu- 
trition, — the child does not thrive, is pale, and its 
muscles are soft and flabby. 

THE SELECTION AKD CARE OF MILK USED FOR U^FANT 
FEEDIISra 

What are the essential points in milk selected for 
the feeding of infants? 

That it comes from healthy cows, and that it is 
clean and fresh. 



58 THE CAEE AND FEEDING OF CHILDEEN 

Is it not important to select a rich milkf 
By no means; in fact the very rich milk of 
highly bred Jerseys and Alderneys has not been 
fonnd nearly so satisfactory in infant feeding as that 
from some other herds, such, for example, as the 
common ^^grade cows." 

WliicTi is the better, milk from one cow or the 
mixed milk of several cows? 

The mixed, or ^^herd milk/' is nsually to be pre- 
ferred, since it varies little from day to day; while 
that from a single cow may vary considerably. 

How fresh is it important that cow's milk should 
he for the best results in infant feeding? 

This depends very much upon the season, and 
how carefully milk is handled. As ordinarily han- 
dled at the dairy and in the home, milk should not 
be used for infants in winter after it is forty-eight 
hours old; in summer not after it is twenty-four 
hours old, and it may be unsafe in a much shorter 
time. When handled with especial care milk may be 
safe for a longer time. 

What are the two essentials in handling milk? 

1. That it be kept clean and free from contami- 
nation. This necessitates that cows, stables, and 
milkers be clean, and that transportation be in sealed 



THE SELECTION AND CAEE OF MILK 59 

bottles ; also that those who handle the milk are them- 
selves healthy and do not come in contact with any 
contagious disease. All milk-pails, bottles, cans, and 
other utensils with which the milk comes in contact 
should be sterilized shortly before they are used, by 
steam or boiling water. 

2. That it be cooled immediately after leaving 
the cows, and kept at as low a temperature as possi- 
ble; to be efl&cient this should not be above 50° F. 

Milk produced under hygienic conditions and 
handled with special care is sold in bottles in 
most cities under the name of ^^certified," or ^^guar- 
anteed,'' milk. When available such milk should be 
used for infants. Of course the extra care bestowed 
in its production and transportation increases the 
cost of the milk, but the best will usually be found 
in the end to be the cheapest. 

How should milk he handled in the home when 
ohtained fresh from the cows? 

That to be used for infants should be strained 
through a thick layer of absorbent cotton or several 
thicknesses of cheese-cloth into quart glass jars or 
milk bottles which should be covered and cooled im- 
mediately, best by placing the bottles quite up to 
their necks in ice water or cold spring water, where 
they should stand for at least half an hour. That 
required for children who take plain milk may now 



60 THE CAEE AND FEEDING OF CHILDEEN 

be poured into half -pint bottles^ stopped with cotton, 
and put in the ice-chest, or the coolest place possible. 
This first rapid cooling is very important and adds 
much to the keeping qualities of the milk. Milk 
loses its heat very quickly when cooled in water, 
but very slowly when it is simply placed in a cold 
room. After standing four or five hours the top- 
milk may be removed; after twelve to sixteen hours 
the cream may be removed. 

How should milk he handled when hoUled milk 
is purchased? 

It should be cooled as just described, as its tem- 
perature is usually somewhat raised during trans- 
portation. If it has been bottled at a dairy, the 
cream or the top-milk may be removed after an hour 
or two. 

How should milk and cream he handled when 
they are purchased in hulk? 

Such milk should never be used for infants when 
it is possible to obtain bottled milk, as it is much 
more liable to contamination. Both cream and milk 
should be poured at once into covered jars and 
kept in the coolest place possible. The cream and 
top-milk will seldom rise upon such milk with a^y 
satisfactory regularity. 



THE SELECTION AND CAEE OF MILK 61 

What are the important things to he secured in 
nursery refrigerators? 

Absolute cleanliness is essential ; hence the inner 
portion should be of tile, glass or metal. Those made 
entirely of metal are often unsatisfactory as in them 
the ice melts very quickly. If the ordinary metal re- 
frigerator sold is encased in a wooden box, we have 
the best form. Another easy way of securing the 
same result is to make for the refrigerator a covering 
or ^^cosey" of felt or heavy quilting, which can be 
easily removed when wet or soiled. 

The compartments of the refrigerator should be 
so arranged that the bottles of milk are either in 
contact with the ice or very near it. The supply of 
ice should be abundant. Often the amount of ice is 
so small, and the bottles so far away, that the tem- 
perature of the milk is never below 60° or 65° F. 
To be really effective a refrigerator should have a 
temperature where the milk is placed of not over 
50° F. The temperature should be tested with the 
nursery thermometer from time to time to ascer- 
tain what results are being obtained. Spoiled milk 
owing to a faulty refrigerator is to be blamed 
for many attacks of acute illness among infants. 
Next to the feeding-bottles it is the one thing 
in the nursery which should receive the closest atten- 
tion. 



62 THE CAEE AND FEEDING OE CHILDEEN 

Are there any objections to the use of vacuum 
(or thermos) hottles for keeping the milk warm or 
cold? 

They are often useful to keep milk cold while 
traveling. They should not be used to keep milk 
warm as for night feedings. Milk which has been 
kept for several hours at the feeding temperature is 
often so changed as to make the baby ill. 



THE MODIFICATIQ]^ OF COW's MILK 



What is meant by the modification of cow's milk ? 
Changing its proportions so that it can be more 
easily digested. 

Is it possible to modify cow's milk so as to make 
it a perfect substitute for mother's milk? 

It is not. Although we can modify cow's milk 
so that the great majority of infants can digest it 
and thrive on it, it must be remembered that there 
are differences which cannot be wholly overcome. 
There are certain peculiar qualities in mother's milk 
which cow's milk does not contain. 

How is this milk, whose proportions have been 
changed, distinguished from the unchanged milk? 
The changed milk is usually called "modified 



THE MODIFICATION OF COW'S MILK 63 

milk" ; the original unchanged milk is known as 
"plain milk/' "whole milk/' "straight milk/' or is 
referred to simply as "milk." 

What are the principal differences betiveen cow's 
milk and mothers milJc? 

Cow's milk has only a little more than half as 
much sugar ; it has nearly three times as much pro- 
teids and salts ; its proteids and fat are different and 
more difficult of digestion; its reaction is decidedly 
acid, that of mother's milk is faintly acid or neutral. 

Are there any other important things to he con- 
sidered? 

Yes; mother's milk is always fed fresh and is 
practically sterile. Cow's milk is generally kept 
twenty-four hours and sometimes much longer. It 
is always to a greater or less degree contaminated 
by dirt and germs, the number of which increases 
rapidly (1) with the age of the milk; (2) in propor- 
tion to the amount of dust or dirt which enters it; 
(3) with any increase in the temperature at which 
the milk is kept. 

It is just as important for success in infant feed- 
ing that these conditions receive attention as that 
iiie proportions of the different elements of the milk 
in-.: right. 



64 THE CAEE AND FEEDING OF CHILDEEN 

How is the acidity of cow's milk overcome? 

Usually by the addition of lime-water ; one ounce 
to twenty ounces of food is generally required. 

If there is a tendency to constipation the milk 
of magnesia (Phillips's) may be used; from one half 
to one teaspoonf ul being added to each twenty ounces 
of food. 

How is the sugar best increased? 

By adding milk sugar to the food ; one ounce by 
measure to each twenty ounces of food will give the 
proper quantity for the first three or four months. 
This will make the proportion about the same as in 
mother's milk. 

How should the sugar he prepared? 

Simply dissolved in boiled water ; if the solution 
is not clear^ or if there is a deposit after standing, 
it should be filtered by pouring through a layer of 
absorbent cotton, half an inch thick, which is placed 
in an ordinary funnel. 

Will not cane (granulated) sugar answer as well? 

IsTot as a rule; however, there are many infants 
who get on very well when cane sugar is used. It 
has the advantage of being much cheaper. A good 
grade of milk sugar is somewhat expensive, costing 
from twenty-five to sixty cents a pound, and cheap 
samples are apt to contain impurities. Moreover, 



THE MODIFICATION OF COW'S MILK 65 

there are some infants in whom diarrhoea is excited 
if the usual amount of milk sugar is given, yet who 
bear cane sugar very well. 

If cane sugar is used, what amount should he 
added? 

Eather less than of milk sugar ; usually from one 
half to three fourths of an ounce, by measure, to 
each twenty ounces of food is as much as is desirable 
for most infants. 

May any other sugar be used? 

Maltose^ (malt sugar) has the advantage of be- 
ing very easily digested and when part of the sugar 
given is maltose, many children gain more rapidly 
in weight than when only milk sugar or cane sugar 
is used. 

Has maltose any other advantages? 
It is somewhat more laxative than other sugars; 
it is therefore useful when there is constipation. 



* Dry preparations of maltose available are " dextri-maltose '^ 
(Mead Johnson &Co., Jersey City), and "nahrzucker^^ (Soxhlet, 
Germany). Liquid preparations are Loeflund's or Borcherdt's 
" malt soup extract '^; somewhat less expensive but rehable is the 
"neutral maltose" (Maltzyme Co., Brooklyn). 

For an infant six months old from two teaspoonfuls to two 
tablespoonfuls of any of these preparations may be added to the 
food for the day, replacing a similar quantity of milk sugar. 

Mellin's food and malted milk also contain a large percentage 
of maltose. 



66 THE CAKE AND FEEDING OF CHILDKEN 

Are there any disadvantages attending the use 
of maltose ? 

It is not well borne if the bowels are loose, nor 
should it be used for children who vomit frequently 
or habitually. 

Is not the purpose of the sugar to sweeten the 
food in order to make it palatable ? 

'Not at all; although it does that, its real use is 
to furnish one of the essential elements needed for 
the growth of the body, and the one that is required 
by young infants in the largest quantity. 

How do we know that this is so f 

By the ±act that in good breast milk the amount 
of sugar is greater than that of the fat, proteids, and 
salts combined. 

We have seen that cow's milh has nearly three 
times as much proteids (curd) and salts as mother's 
milk. How are these to he diminished? 

By diluting the milk. 

Will it he sufficient to dilute the milk twice (i. e., 
add two parts of water to one part of milk) ? 

l^ot for a very young infant. Although this will 
give about the quantity of proteids present in moth- 
er's milk, it is better for most infants in the begin- 
ning to dilute the milk at least three times. 



THE MODIFICATION OF COW'S MILK 67* 

// cow^s milk is properly diluted and lime-water 
and sugar added does it then resemble mother s milk ? 
No ; the mixture contains less fat. 

75 it desirable to increase the fat to the proportion 
present in mother s milk? 

On account of the difference in digestibility it is 
\isually impossible to give to young infants as much 
fat in cow's milk as is present in good mother's milk. 
For most healthy infants it is, however, desirable to 
give more fat than is contained in cow's milk when 
this has been simply diluted. 

What is the easiest way to secure a milk which 
contains the proper proportion of fat f 

By increasing the fat in the milk before dilution. 
It may be done by using top-milk or a mixture of 
milk and Cream. 

What is top-milk? 

It is the upper layer of milk removed after 
standing a certain number of hours in a milk bottle, 
glass jar, or any tall vessel with straight sides. It 
contains most of the cream and some of the milk 
just below. 

The strength of the top-milk is measured by the 
fat it contains — e. g., 7-per-cent milk contains 7 per 



68 THE CARE AND FEEDING OF CHILDEEN 

cent fat, etc. This is the top-milk of most use in in- 
fant feeding. . If a larger number of ounces is re- 
moved the percentage of fat will of course be lowered. 

When and how should top-milk he removed? 

If milk fresh from the cow, or before the cream 
has risen, is put into bottles and rapidly cooled, the 
top-milk may be removed in as short a time as four 
hours. In the case of bottled milk it makes little 
difference if it stands a longer time, even until the 
next day. The best means of removing it is by a 
small cream-dipper^ holding one ounce; although it 
may be taken off by a spoon or siphon. It should 
not be poured off. 

Does the upper half always contain 7-per-cent 
fat? 

i^o ; this varies with the length of time the milk 
has stood, and still more with the richness of the 
milk used. 

The richness of the milk depends on several fac 
tors : whether it is from a herd or a single cow, also 
on the breed of the cow and on the manner of feed- 
ing. In good average milk the cream forms about 
one-sixth of the whole amount after the milk has 
stood four or five hours. 



^ Obtained from any of the Walker-Gordon milk laboratories, 
from James Dougherty, No. 411 West 59th Street, New York, 
and from many druggists. Price, 20 cents. 



THE MODIFICATION OF COW'S MILK 69 

How can we obtain 7'per-cent top-milk with the 
dif event hinds of cow's milk ? 

From a rather poor milk, by removing the upper 
eleven ounces from a quart, or about one third. 

From a good average milk, by removing the upper 
sixteen ounces, or one half. 

From a rich Jersey milk, by removing the upper 
twenty-two ounces, or about two thirds. 

What is cream? 

Cream is often spoken of as if it were the fat 
in milk. It is really the part of the milk which 
contains most of the fat. It differs from milk chiefly 
in containing much more fat. 

In what ways is cream now obtained? 

(1) By skimming, after the milk has stood usu- 
ally for twenty-four hours; this is known as ^ ^grav- 
ity cream.'' (2) By an apparatus called a sepa- 
rator; this is known as "centrifugal cream"; most 
of the cream now sold in cities is of this kind. The 
richness of any cream is indicated by the amount of 
fat it contains. 

The usual gravity cream sold has from 16 to 20 
per cent fat. The cream removed from the upper 
part (one fifth) of a bottle of milk has about 16 per 
cent fat. The usual centrifugal cream has 18 to 20 



70 THE CAEE AND FEEDING OE CHILDREN 

per cent fat. The heavy centrifugal cream has 35 
to 4-0 per cent fat. 

Is cream more digestible than milk? 

This depends much upon circumstances. For 
most infants it is much less so; many serious dis- 
turbances of digestion are caused by cream. 



FOOD FOR HEALTHY IISTFANTS ^ 

What are the important points to he remembered 
in modifying cow's milk for feeding during the early 
months ? 

That the proportions of the different elements, — 
f atj sugar and proteids — should be those best suited 
to the child's digestion and the needs of the body 
for growth. 

When given in proper amount, difficulty is not 
likely to be found by healthy infants with the diges- 
tion of any of the elements of milk ; but when given 
in excess or when digestion is deranged, any of them 
may cause trouble. 

^ The directions and formulas given in the following pages are 
intended only for guidance in feeding children who are not suf- 
fering from any special disturbance of digestion; directions for 
such conditions are given in a later chapter. 



FOOD FOE. HEALTHY INFANTS 71 

What relation should the fat bear to the proteids 
during this period? 

For most infants with good digestion the best 
results are obtained when the fat is higher than the 
proteids — e. g., twice as much. However, this is not 
true of all. There are many healthy infants who are 
unable to digest this proportion of fat, and who do 
much better when the fat and the proteids are about 
equal. 

Two groups of formulas are therefore useful: 
(1) Those in which the fats are higher than the 
proteids, derived from top-milk; (2) those in which 
the two are about the same, derived from whole 
milk. 

How can one obtain formulas in which the fat 
is twice the proteids? 

By using for dilution a 7-per-cent milk, for in 
this the fat is exactly twice the proteids. 

How can one get the 7-per-cent milh? 

(1) Most easily as top-milk, as described on page 
69; or (2) by mixing three parts of milk and one 
part of ordinary (16-per-cent) cream; (3) from any 
of the milk laboratories it may be obtained directly. 

How should the food be prepared? 
It is convenient in calculation to make up twenty| 
ounces of food at a time. The first step is to obtain 



72 



THE CAEE AND FEEDING OF CHILDEEN 



the 7-per-ceiit milk. Then to take the number of 
ounces of this that are called for in the formula 
desired. 

ISToTE. — One should not make the mistake of 
taking from the top of the bottle only the number 
of ounces needed in the formula, as this may give 
quite a different result. 

There will be required in addition one ounce of 
milk . sugar ^ and one ounce of lime-water in each 
twenty ounces. The rest of the food will be made 
up of boiled water. 

These formulas written out would be as follows : 

FORMULAS FROM 7-PER-CENT MILK' 





I. 


II. 


III. 


IV. 


V. 


VI. 


VII. 


VIII. 


IX. 




Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


7-per-cent milk . . 


2 


3 


4 


5 


6 


7 


8 


9 


10 


Milk sugar 


1 


1 


1 


1 


1 


y^ 


y 


% 


y^ 


Lime-water 


1 


1 


1 


1 


1 


1 


1 


1 


1 


Boiled water 


17 


16 


15 


14 


13 


12 


11 


10 


9 




20 


20 


20 


20 


20 


20 


20 


20 


20 



The approximate composition of these formulas 
expressed in percentages is as follows : 



1 If the milk sugar be measured in the milk-dipper, two scant 
dipperfuls may be calculated as one ounce. If measured in a 
tablespoon, three even tablespoonfuls may be calculated as one 
oimce. 



FOOD FOR HEALTHY INFANTS 



73 



FOBMULA. 


Fat. 


Sugar. 


Proteidfl. 


I 


0.70 
1.00 
1.40 
1.75 
2.00 
2.40 
2.80 
3.10 
3.50 


5.00 
6.00 
6.00 
6.00 
6.00 
6.00 
6.00 
6.00 
6.00 


0.35 


II 


0.50 


Ill 


0.70 


IV 


0.87 


V 


1.00 


VI 


1.20 


VII 


1.40 


VIII 


1.55 


IX 


1.75 







Why is it necessary to make the food so weaJc 
at first? 

Because the infant's stomach, is intended to digest 
breast milk, not cow's milk; but if we begin with a 
very weak cow's milk the stomach can be gradually 
trained to digest it. If we began with a strong milk 
the digestion might be seriously upset. 

How rapidly can the food he increased in strength 
from Formula I to II, from II to III, etc. f 

K"o absolute rule can be given. Usually we begin 
with No. I on the second day ; ITo. II on the fourth 
day; ITo. Ill at seven to ten days; but after that 
make the increase more slowly. A large infant with 
a strong digestion will bear a rather rapid increase 
and may be able to take No. V by the time it is three 
or four weeks old. A child with a feeble digestion 
must go much slower and may not reach No. V be- 
fore it is three or four months old. 



74 THE CAEE AND FEEDING OF CHILDEEN 

It is important with all children that the increase 
in the food be made very gradually. It may be best 
with many infants to increase the milk by only half 
an onnce in twenty ounces of food, instead of one 
ounce at a time as indicated in the tables. Thus 
from 3 ounces, the increase would be to 3^^ ounces; 
from 4 ounces to 41^ ounces, etc. At least two or 
three days should be allowed between each increase 
in the strength of the food. 

The quantities proper for the different ages, and 
the intervals of feeding, are given on page 110. 

WTiat general rule can he given for increasing the 
food? 

To increase when the infant is not satisfied 
but is digesting well, and always to wait at least 
two or three days between each addition to the 
food. 

For fuller directions about increasing the food see 
pages 82 and 83. 

How does an infant show that he is not satis- 
fied? 

He drains the bottle eagerly and cries when it is 
taken away. He often forms the habit of sucking 
his fingers immediately after. He begins to fret 



FOOD FOR HEALTHY INFANTS 75 

half an hour or an hour before the next feeding 
is due. 

Under such circumstances is it better to increase 
the strength or the quantity of the food? 

It is well to alternate; at first increasing the 
strength, next the quantity, then the strength, and 
so on. 

Up to what age should formulas from 7'per-cent 
milk he continued? 

Usually up to six or seven months. 

Vfhat formulas should follow these? 
The change should gradually be made to those 
from whole milk. 

How may this he done? 

Instead of removing the upper 16 ounces as 
top milk, one may for two weeks remove the upper 
18 ounces as top milk. For the next two weeks 
remove the upper 20 ounces as top milk. For the 
next two weeks remove the upper 24 ounces as top 
milk. 

After this the bottle may be shaken up and the 
whole milk used. 

After these changes should the numher of ounces 
of milk in the food remain the same ? 

Only while the upper 18 ounces are used. When 



76 THE CARE AND FEEDING OF CHILDREN 

the upper 20 ounces are removed as top-milkj each 
20 ounces of the food should contain 11 ounces of 
this milk. When the upper 24 ounces are removed, 
each 20 ounces of the food should contain 12 ounces 
of this milk. When the whole milk is used, each 
20 ounces of the food should contain 13 ounces of the 
milk. 

These formulas written out in full would be as 
follows : 





I. 


II. 


III. 


Top-milk 

Milk sugar 

Lime-water. . . 

Gruel 

Water 


Oz. 

r Upper \ .. 
\ 20 oz./^^ 

1 

8 


Oz. 

f Upper \ .o 
\ 24 oz./^^ 

1 

4 
3 


Oz. 
/ Whole \ .Q 
\ milk./ ^^ 

/4 
1 
6 





20 


20 


20 



Usually by the time ITo. II is reached farina- 
ceous food may be introduced in the form of gruel, 
as explained on page 86. 



How long may No. Ill he continued? 

If conditions have been such that the schedule 
could be followed this formula would be reached at 
seven or eight months. 



FOOD FOE HEALTHY INFANTS 77 

With little or no change this may be continued 
until the child is nearly a year old, the amount of 
food given at each feeding being, of course, gradually 
increased. See page 110. 

In the series of formulas given in the table the 
quantities are mentioned for making only twenty 
ounces of food. How should it he prepared when 
more than this quantity is needed? 

It is equally convenient to make up 25 ounces, 
30 ounces, 35 ounces, or 40 ounces at a time. 

To make 

25 ounces of any formula add one quarter more of each ingredient 

30 . " '* " " one half 

35 " ** " " three quarters " " " 

40 ** " " " as much 

Thus, 25 ounces of Formula I v^ould be obtained 
by using 2|- ounces of milk, IJ ounces of sugar and 
lime-v^ater, 21 J ounces of water; 30 ounces of the 
same would require 3 ounces of milk, 1^ ounces of 
lime-water and sugar, and 25^ ounces of water; 35 
ounces would require 3|- ounces of milk. If ounces 
of lime-water and sugar, and 29f ounces of water. 
The amount of water need not be calculated in any 
case, but after measuring carefully the other ingre- 
dients enough water should be added to bring the total 
up to the amount required. 



78 THE CAEE AND FEEDING OF CHILDKEN 
FOKMULAS FROM WHOLE MILK 

Why is such a series of formulas necessary for 
young infants? 

Not all children can take as high fats as are given 
in formulas derived from 7-per-cent milk. 

How is this shown? 

Sometimes simply by the fact that they lose ap- 
petite or do not thrive properly. Sometimes by 
marked symptoms of indigestion, most frequently 
habitual vomiting, occasionally by constipation with 
dry crumbly stools. In general the advice may be 
given that if a child is not doing well upon the first 
series of formulas a change to the second should be 
made. 

Are there any disadvantages in using this group 
of formidas? 

It is certainly true that there is with most chil- 
dren a greater tendency to constipation than when 
the formulas from top-milk can be given. It is also 
true that when the fat is made low the gain in weight 
is less. Because of this fact other things must be 
introduced to take the place of the fat. 

What elements can take the place of the fat? 
Principally the carbohydrates — sugar and starch. 



FOEMULAS FKOM WHOLE MILK 



79 



More sugar stioiild be given and starches should be 
introduced earlier than when higher fats are used. 

Formula^from Whole Milk {4-per-cent Fat) 





V 

I. 


II. 


III. 


IV. 


V. 


VI. 


VII. 


VIII. 


IX. 


X. 




Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Oz. 


Milk 


4 


5 


6 


7 


8 


9 


10 


11 


12 


13 


Sugar 


1 


1 


1 


1 


1 


i 


1 


i 


i 


i 


Lime-water . . 


1 


1 


1 


1 


1 


1 


1 


1 


1 


1 


Water 


15 


14 


11 


8 


5 


4 


3 


2 


1 





Gruel 








2 


4 


6 


6 


6 


6 


6 


6 




20 


20 


20 


20 


20 


20 


20 


20 


20 


20 



The approximate composition of these formulas 
expressed in percentages is as follows : 



Formula. 


Fat. 


Sugar. 


Proteids. 


I 


0.80 
1.00 
1.20 
1.40 
1.60 
1.80 
2.00 
2.20 
2.40 
2.60 


6.00 
6.00 
6.00 
6.50 
6.50 
6.00 
6.00 
6.00 
6.00 
6.00 


0.70 


II 


0.90 


Ill 


1.00 


IV 


1.20 


V 


1.40 


VI 


1.60 


VII 


1.80 


VIII 


2.00 


IX 


2.10 


X 


2.30 







Gruel for Formulas III, IV, and V should be 
made, one level tablespoonful of wheat, barley or oat 
flour to 8 ounces of water. 



80 THE CAKE AND FEEDING OF CHILDKEN 

For Formulas VI, VII, VIII, IX, and X, two 
level tablespoonfuls to 8 ounces of water should be 
used. 

It will be noted that No. X of this series is the 
same as 'No. Ill, page 76. 

How should the food he made up if these formulas 
are used? 

The gruel is cooked separately as described on 
page 153; when it has partly cooled the milk, lime- 
water, milk sugar and water are added and thor- 
oughly mixed. <» 

How should the strength of the food he increased 
when this series of formulas is used? 

The general rules given on pages 74 and 75 may 
be followed, except that on account of the higher pro- 
teids in this series the increase after No. Ill should 
be made more slowly ; so that ordinarily No. V would 
not be reached until about two months. 

How rapidly after this time should the food he 
strengthened? 

In general the advance from one formula to the 
next stronger should be made once a month. It is 
often desirable to make half the increase in the mid- 
dle of the month. 

If the schedule is followed No. X would be 



GENEEAL EXILES FOE GUIDANCE 81 

reached at seven or eight months and may be con- 
tinued for the balance of the first year. 



GENERAI. EULES FOR GUIDANCE IIT THE USE OF THE 
rOEMULAS GIVElSr 

It should again be emphasized that these for- 
mulas are not intended for sick children nor for 
those suflFering from any marked symptoms of in- 
digestion. For such infants special rules are given 
later. 

WJiat should he the guide in deciding upon a 
formula with which to hegin for a child who is to 
he artificially fed? 

The age and the weight are of some importance, 
but the best guide is the condition of the child's 
digestive organs. One should always begin with a 
weak formula, particularly, (1) with an infant pre- 
viously breast fed; (2) with one just weaned, as a 
child who has never had cove's milk must at first 
have weaker proportions than the age and the weight 
would seem to indicate; (3) with infants whose pow- 
er of digestion is unknown. If the first formula 
tried is weaker than the child can digest, the food 
can be strengthened every three or four days until 
the child's capacity is reached. On the contrary, 



82 THE CAEE AND FEEDING OF CHILDREN 

if the food is made too strong at first, an attack of 
indigestion will probably follow. 

How should the food he increased in strength ? 

The first essential is that it be done very gradu- 
ally; abruptly increasing the food usually causes a 
disturbance of digestion. 

It is never wise to advance more rapidly in 
strengthening the food than from one formula to the 
next one in any of the series given; with many in- 
fants it is better to make the steps of increase only 
half as great as those indicated (page 72). 

Hoiu rapidly should the food he increased in 
quantity ? 

The increase should not be more than a quarter of 
an ounce in each feeding; never of tener than every 
three days and usually not oftener than once a week. 

When should the food he increased? 

In the early weeks an increase may be necessary 
every few days; in the later months sometimes the 
same formula may be continued for two or three 
months. It is, however, impossible to give a definite 
rule as to time. One cannot say with any child that 
an increase is to be made every week or every two 
weeks. A much better guide is the condition of the 
digestion as shown by the child's appetite, the char- 



GENEEAL EULES FOE GUIDANCE 83 

acter of the stools^ the sleep, and the general disposi- 
tion. 

The signs indicating that the food should be in- 
creased are, that the infant is not satisfied, not gain- 
ing in weight, but is digesting well, i. e., not vomit- 
ing, and having good stools. One should not increase 
the f ood^ however, so long as the child seems perfectly 
satisfied and is gaining from four to six ounces a 
week, even though both the quantity and the strength 
of the food are considerably below the average ; nor 
should the food be increased if the child is gaining 
from eight to ten ounces a week, even if he seems 
somewhat hungry. The appetite is not always a safe 
guide to follow. There are many infants who will 
habitually take more food than they are able to digest 
and there is a danger of increasing the amount of 
food beyond the normal capacity of the child's stom- 
ach. The ultimate results of such overfeeding are 
serious disturbances of digestion and in some in- 
stances dilatation of the stomach. 

How can one hnow whether the strength or the 
quantity of the food should he increased? 

In the early weeks it is well first to increase 
the strength of the food, the next time to increase 
the quantity, then the strength again, etc. After the 
fourth or fifth month, the quantity, chiefiy, should 
be increased. 



84 THE CAEE AND FEEDING OF CHILDREN 



If a slight disturhance or discomfort occurs after 
the food has heen strengthened^ is it best to go hach 
to the weaker formula or to persist with the new one ? 

Symptoms of minor discomfort are seen for a day 
or two with many infants after an ordinary increase 
in food; but in most cases an infant soon becomes 
accustomed to tbe stronger food and is able to digest 
it. If, however, the symptoms of disturbance are 
marked, one should promptly go back to the weaker 
formula. The next increase should be a smaller one. 

Should one he disturbed if for the first two or 
three weeks of artificial feeding the gain in weight 
is very slight or even if there is none ? 

'Not as a rule. If the infant does not lose weight, 
is perfectly comfortable, sleeps most of the time, 
and does not suffer from any symptoms of indiges- 
tion, such as colic, vomiting, etc., one may be sure 
that all is going well and that the infant is becoming 
used to his new food. As the child's appetite im- 
proves and his digestion is stronger, the food may be 
increased every few days and very soon the gain in 
weight will come and will then be continuous. If, 
however, the scales are watched too closely and, be- 
cause there is only a slight gain in weight or none 
at all, the food is rapidly increased, an acute dis- 
turbance of digestion is pretty certain to follow. 



GENERAL RULES FOR GUIDANCE 85 

Is not constipation likely to occur if the child is 
on a very weak food? 

It is very often seen and is due simply to the 
small amount of residue in the intestine. But if the 
bowels move once a day, one should not be disturbed 
even when the movements are small and somewhat 
dry. As the food is gradually strengthened, this con- 
stipation soon passes off; while if injections, suppos- 
itories, or cathartics are used to produce freer move- 
ments, the functions of the bowels are likely to be 
disturbed. 

Under what circumstances should the food he 
reduced? 

Whenever the child becomes ill from any cause 
whatever, or whenever any marked symptoms of indi- 
gestion arise. 

How may this he done? I 

If the disturbance is only a moderate oiie and the 
food has been made up for the day, one third may be 
poured off from the top of each bottle just before it 
is given, and this quantity of food replaced by the 
same am:t)unt of boiled water. 

If ihe disturbance is more severe, the food should 
be immediately diluted by at least one half and at 
the same time the quantity given should be reduced. 

For a severe acute attack of indigestion the regu- 



S6 THE CAEE AND FEEDING OF CHILDREN 

lar food should be omitted altogether and only water 
given until the doctor has been called. 

If the food has been reduced for a disturhance 
of digestion^ how should one return to the original 
formula? 

While the reduction of the food should be im- 
mediate and considerable, the increase should be very 
gradual. After a serious attack of acute indigestion, 
when beginning with milk again, it should not be 
made more than one fifth the original strength, and 
from ten days to two weeks should pass before the 
child is brought back to his original food, which 
should be done very gradually. It is surprising how 
long a time is required with young infants before 
they completely recover from an attack of acute indi- 
gestion, even though it did not seem to be very severe. 
The second disturbance always comes from a slighter 
cause than the first one. 



THE ADDITION OF OTHER FOODS TO MILK 

When should other food he added to the milk? 

This depends upon circumstances. If formulas 
from 7-per-cent milk are given, farinaceous food is 
usually begun at six or seven months. If formulas 
from whole milk are used it may be given earlier ; a 



THE ADDITION OF OTHER FOODS TO MILK 87 

small amount may be added as early as two months, 
and at three months more may be given. The reason 
for this has already been mentioned (page 79), 

What further additions may he made to the diet 
of healthy infants during the first year? 

Beef jnice, the white of egg, and orange jnice. 

How and when may heef juice he used? 

With infants who are strong and thriving satis- 
factorily it may be begun at ten or eleven months; 
two teaspoonfuls may be given daily, diluted with 
the same quantity of water, fifteen minutes before 
the midday feeding; in two weeks the quantity may 
be doubled; and in four weeks six teaspoon- 
fuls may be given. The maximum quantity at one 
year should not be more than two or three table- 
spoonfuls. 

With delicate infants who are pale and anaemic, 
beef juice is more important, and it may often be 
wisely begun at five or six months in half the quan- 
tities mentioned. 

When should white of egg he used? 

Under the same conditions as beef juice, particu- 
larly with infants who have difficulty in digesting 
the proteids (curd) of milk. At six months half 
the white of one egg may be given at one time, and 
soon after this the entire white of one Qgg, The best 



88 THE CARE AND FEEDING OF CHILDREN 

manner of cooking is the ^^coddled'' egg (see page 
157). 

When should orange juice he begun? 

There are many infants whose nutrition is dis- 
tinctly benefited by giving small quantities of orange 
juice as early as five or six months, when two or three 
teaspoonfuls a day may be given an hour before the 
feeding. By the time one year is reached from two 
to four tablespoonfuls a day may be given. It is par- 
ticularly useful when there is constipation. It should 
always be strained, and care should be taken that it is 
sweet and fresh. 

SUBSTITUTES FOR FRESH MILK 

When no fresh cow's milk can he obtained, what 
substitutes are most reliable? 

Condensed milk ; evaporated milk ; sterilized milk 
in bottles ; dried milk ; goat's milk. Of the condensed 
milks available in the United States, Borden's Eagle 
brand is probably the most reliable. This contains a 
large amount of cane sugar. Condensed milk with- 
out any addition of sugar is sold in this country fresh 
and in cans under the name of ^^evaporated milk." 
The Bear brand of Swiss condensed milk is perhaps 
as trustworthy as any obtained in Europe. 



SUBSTITUTES FOR FRESH MILK 89 

Dried milk is derived from fresh whole milk by 
rapid evaporation of the water. Made from partially 
skimmed milk, with the addition of milk sngar, it 
is sold as a food for infants under the name of mam- 
mala. It requires only to be dissolved in water for 
feeding. A somewhat similar preparation is sold in 
Europe under the name of glaxo. Sterilized milk 
sold in bottles is widely used in Europe, but not 
much in this country. On the whole, it is not so con- 
venient, and I think less reliable than condensed 
milk. 

The evaporated milk is to be preferred in infant 
feeding to the sweetened condensed milk. To this 
any form and any amount of sugar desired may 
be added; the objections to the use of the large 
amount of cane sugar are thus avoided. 

All of these substitutes are open to the same ob- 
jections, and though convenient for travelling and 
often necessary for use in foreign countries, they are 
not to be advised as permanent infant foods where 
fresh cow's milk can be obtained ; they are, however, 
to be preferred to the proprietary infant foods. 

Goat's milk may be had in many foreign coun- 
tries, and when fresh and produced in cleanly condi- 
tions it is to be preferred to any of the substitutes 
mentioned above as a permanent food. For most in- 
fants it requires the same modification as cow's milk. 



90 THE CABE AND FEEDING OF CHILDREN 



OVEKFEEDINa 

What is meant hy overfeeding? 

Giving an infant too mucli food ; either too mucli 
at one time or too frequently. Overfeeding is some- 
times practised during the day, but is chiefly done 
at night. 

Is not an infant's natural desire for food a proper 
guide as to the quantity given? 

The appetite of a perfectly normal infant usu- 
ally is; but overeating is a habit gradually acquired 
and may continue until twice as much food as is 
proper is taken in the twenty-four hours. This habit 
is most frequently seen in infants whose digestion 
is not quite normal; because of the temporary relief 
from discomfort experienced by taking food into the 
stomach, they often appear to be hungry the greater 
part of the time, especially at night. 

What are the causes of overfeeding? 

The most common one is the habit of watching 
the weight too closely, and the conviction on the part 
of the mother or nurse that, because a child is not so 
large nor gaining so rapidly as some other infant 



OVEEFEEDING 91 



of the same age, more food or stronger food should 
be given. 

What harm results from overfeeding? 

All food taken in excess of what a child can digest 
becomes a burden to him. The food lies in the 
stomach or bowels undigested, ferments, and causes 
wind and colic. When overfeeding is longer con- 
tinued, serious disturbances of digestion are soon 
produced. The infant is restless, fretful, constantly 
uncomfortable, sleeps badly, stops gaining and may 
even lose in weight. Such symptoms may lead 
to the mistaken conclusion that too little food 
is given, and it is accordingly increased, when it 
should be diminished. One of the results of long- 
continued overfeeding is dilatation or stretching of 
the stomach. 

What should guide one as to the quantity of food 
to he given to any infant? 

(1) The size of the infant's stomach at the dif- 
ferent months; (2) the amount of milk which the 
healthy nursing infant gets; (3) the quantities with 
which most children do best. The table of quantities 
and intervals of feeding, on page 110, gives the aver- 



92 THE CAEE AND FEEDING OF CHILDEEN 

age figures derived from these sources. It is seldom 
wise to go beyond the limits there stated ; nor should 
one insist upon giving any fixed amount if it is 
clearly more than the child wants or can be made to 
take except by continued coaxing. 

LOSS OF APPETITE 

What is to he done when, without any other signs 
of illness, a child's appetite gradually fails? 

This is often the result of a long period of over- 
feeding or the use of milk too rich in fat. If in all 
other respects the child seems well and simply does 
not want his food, it should be offered at regular 
hours, but not more frequently ; on no account should 
he be coaxed, much less forced, to eat, even though he 
takes only one half or one third the usual quantity. 
The intervals between feedings should not be short- 
ened but rather lengthened. Often, with a child a 
year old, it is necessary for a time to reduce the num- 
ber of feedings to four or even three in twenty-four 
hours. Water, however, may be offered at more fre- 
quent intervals. The food should be weakened rather 
than strengthened. No greater mistake can be made 
than, because so little is taken, coaxing or forcing 
food at short intervals through fear lest the child may 
lose weight. ""^^ 



CHANGES EEQUIEED BY SPECIAL SYMPTOMS 93 



THE CHAIS-GES 11^ THE FOOD REQUIRED BY SPECIAL 
SYMPTOMS OR COl^DITIOXS 

Why is it that an infant so often vomits some of 
its food within a few moments after finishing its 
bottle? 

Usually because the quantity is too large. Some- 
times it is due to the fact that the food is taken too 
rapidly, from too large a hole in the nipple. It may 
be due to too tight clothing, or to moving the child 
about in such a way as to press upon the stomach. 

What are the principal causes of, and the changes 
in the food required by, habitual vomiting, regurgi- 
tation, or spitting up of small quantities of food be- 
tween feedings, often repeated many times a day? 

This is a symptom of gastric indigestion, and a 
most troublesome one. In such conditions formulas 
from top-milk should not be used, but rather those 
from whole milk. The lime-water should be in- 
creased. 

In cases not improved by these changes it may be 
necessary to reduce the fat still further. This is espe- 
cially true if the whole milk used is very rich. Under 
these circumstances one should remove some of the 
cream from the top of the bottle before shaking it up. 

Hoiv much cream should be removed? 

At first 4 ounces may be taken off, after which 



94 THE CARE AND FEEDING OF CHILDREN 

the bottle is shaken and the balance used as in the 
formulas from whole milk. After a few days if the 
symptoms improve only 3 ounces of cream need be 
removed. After a few days longer only 2 ounces are 
removed^ then only 1 ounce and finally the child is 
brought back to the mixtures from whole milk. 

How much lime-water may he used? 

Improvement in vomiting may follow if the 
amount of lime-water is doubled. There is rarely 
any advantage in using more than this; — i. e., 2 
ounces in 20 ounces of food. 

Is vomiting often increased by the sugar ? 

This is not likely with milk sugar if only the 
quantity mentioned in the formulas is used. How- 
ever, the use of much cane sugar or of maltose often 
aggravates the vomiting. Therefore under these 
conditions the use of any of the malted foods should 
be carefully avoided. 

What changes should he made in the intervals of 
feeding ? 

Under no circumstances should a vomiting baby 
be fed oftener than every three hours, and sometimes 
the intervals should be longer. 



CHANGES BEQUIEED BY SPECIAL SYMPTOMS 95 

What changes should he made in the quantity 
given at a feeding? 

It is difficult to lay down an absolute rule. Usu- 
ally a small quantity of a stronger food is better than 
a large quantity of a weak food. But one should not 
give more than is advised in the schedule for the age 
of the child. To give somewhat smaller quantities is 
sometimes useful, but often this is of no assistance. 

What are the causes of, and food changes required 
hy, a constant and excessive formation of gas in the 
stomach, leading to distention and pain, or eructa- 
tions (belching) of gas and often of a sour, watery 
fluid? 

This is often associated with habitual vomiting, 
and is due to similar causes, but particularly to an 
excess of the sugars mentioned. 

Besides the measures already described to con- 
trol vomiting, benefit sometimes follows the use of 
benzoate of soda, of which half a grain may be added 
to each ounce of food and continued for a few weeks 
if necessary. 

What changes should he made in the food when 
there is hahitual flatulence and colic? 

Flatulence occurs when there is excessive forma- 
tion of gas in the intestines. If this is readily ex- 



96 THE CAKE AND FEEDING OF CHILDREN 

pelled the child suffers no great discomfort; but if 
not, some distention of the bowel takes place and colic 
results. 

Both these conditions are greatly aggravated by 
constipation, and to relieve the constipation is often 
the best means of controlling them. 

The gas usually arises from faulty digestion of 
the sugars or starch, and any of these elements 
of the food may need to be reduced, particularly 
the starch, which in many cases should be omitted 
altogether. 

What changes should he made in the food for 
chronic constipation? 

Nothing should be done if the child has one good 
movement a day. Such a child cannot be called con- 
stipated. 

The constipation of the first weeks of life has 
been already referred to (page 85) ; it usually dis- 
appears as the food is gradually strengthened in all 
its proportions. 

Habitual constipation at a later period is difficult 
to overcome by diet alone. It sometimes depends 
upon the fact that the proteids are too high, and 
sometimes that the fat is too low. Hence it is more 
frequent when infants are fed upon formulas from 
whole milk, than when formulas from top-milk, or 



CHANGES REQUIEED BY SPECIAL SYMPTOMS 97 

milk and cream are used. But it is not desirable 
to use a top-milk containing more than 7-per-cent fat 
for this purpose as other disturbances of digestion 
may be produced. 

A part or all of the milk sugar may be replaced 
by maltose (page 65). 

The substitution of the milk of magnesia for the 
lime-water as recommended on page 64 will often be 
found useful. After a short time the amount given 
each day may gradually be reduced until finally it is 
discontinued. 

To infants over nine months old, orange juice 
may be given. 

What special modifications are required durinff 
very hot weather? 

During the warm season it is well to make the 
proportion of fat less than during cold weather. 
During periods of excessive heat it should be muck 
less. The fat is reduced by using formulas from 
whole milk in place of the 7-per-cent milk. At such, 
times also the usual food should be diluted and water 
given freely between the feedings. 

What changes should he made in the food of a 
child who, with all the signs of good digestion, gains 
very little or not at all in weight? 

If the child seems hungry the quantity of food 
may be increased, or the food may be made stronger 



98 THE CAEE AND FEEDING OF CHILDREN 

by using the next higher formula of the series. If 
the child is not hungry it is unwise to attempt to in- 
crease either the quantity or the strength of the food ; 
for a child thrives, not upon what he swallows but 
upon what he digests. Coaxing or forcing the child 
in order to increase the amount of food taken is al- 
most certain to upset digestion and cause actual loss 
in weight. 

Changes in the milk formula are often of assist- 
ance. In general, such children as we are consider- 
ing do best upon milk formulas which are rather low 
in fat, i. e., those from whole milk or even from par- 
tially skimmed milk (page 93) rather than those from 
top-milk, and which are at the same time high in 
carbohydrates (sugar and starch). The starch gruel 
used may often be made twice the usual strength. 
Without reducing the quantity of milk sugar one of 
the preparations of maltose (page 65) may be added, 
beginning with two teaspoonfuls and gradually in- 
creased to two tablespoonfuls daily, unless vomiting 
or looseness of the bowels is produced. 

It is also important to look after the other factors 
in the child's life, — the care, sleep, fresh air, etc., for 
with these rather than with the food the trouble 
often lies. 

What should be done ivith infants who in spite of 
all the usual variations in the milk continue to have 



CHANGES EEQUIEED BY SPECIAL SYMPTOMS 99 

symptoms of discomfort or indigestion and do not 
thrive ? 

Except inmates of institutions, who form a class 
by themselves, most infants who receive proper care 
thrive upon milk if the proportions suited to the 
digestion are given. Still there are some who do not. 
The nutrition of such is always a matter of difficulty. 

If a wet-nurse is available the employment of one 
is the thing most likely to succeed, particularly if the 
infant is under three or four months old. 

Some infants may thrive upon sterilized or boiled 
milk who seem to be unable to digest raw milk ; both 
therefore should be tried. Success sometimes follows 
a change to condensed milk (page 118). It is more 
likely to agree when the symptoms are chiefly intes- 
tinal (colic, flatulence, constipation, undigested stools 
or diarrhoea) than when the symptoms are chiefly gas- 
tric (vomiting, regurgitation, etc.). Condensed milk 
should not be continued indefinitely; after a period 
varying from a few weeks to two or three months the 
infant should be brought back gradually to the usual 
milk formulas. 

What changes in the food are required hy slight 
indisposition? 

For slight general disturbances such as dentition, 
colds, sore throats, etc., it is usually sufficient simply 

V f\ 



100 THE CAEE AND FEEDING OF CHILDEEN 

to dilute the food. If this is but for two or three 
feedings, it is most easily done by replacing with 
boiled water an ounce or two of the food removed 
from the bottle just before it is given; if for several 
days, a weaker formula should be used. 

What changes should he made for a serious acute 
illness? 

For such attacks as those of pneumonia, bron- 
chitis, measles, etc., attended with fever, the food 
should be diluted and the fat reduced as described 
on page 97. It should be given at regular intervals, 
rather less frequently than in health. Water should 
be given freely between the feedings. Food should 
not be forced in the early days of an acute illness, 
since the loss of appetite usually means an inability 
to digest much food. 

What immediate changes should he made in the 
food when the child has an acute attach of gastric in- 
digestion with repeated vomiting, fever, pain, etc.? 

All milk should be stopped at once, and only 
boiled water given for ten or twelve hours; after- 
ward barley-water or whey may be tried, but no 
milk for at least twenty-four hours after the vom- 
iting has ceased. When beginning with modified 
milk, formulas made from skimmed milk as described 



CHANGES EEQUIEED BY SPECIAL SYMPTOMS 101 

on page 93 should be used for a few days. The pro- 
portion of lime-water may be doubled. 

What changes should be made for an attach of in- 
testinal indigestion with looseness of the boivels? 

If this is not severe (only two or three passages 
daily), the milk sugar should be omitted, the fat 
should be lowered in the manner stated just above, 
and the milk should be boiled for five minutes. If 
undigested milk appears in the stools, it may be 
diluted with an equal amount of barley water. If 
the diarrhoeal attack is more severe, and attended by 
fever and foul-smelling movements of greater fre- 
quency, all milk should be stopped immediately, and 
the diet mentioned just above under the head of acute 
disturbances of the stomach should be employed. 

What changes in the food should be made when 
the child seems to have very little appetite and yet 
is not ill? 

The number of feedings should be reduced, the 
interval being lengthened by one hour or even more. 
No greater mistake can be made than to offer food 
every hour or two to an infant who is not hungry. 
That only prolongs and aggravates the disturbance. 

What other conditions besides the food greatly 
influence the child's digestion ? 

Proper clothing, warm feet, regular habits, fresh 



102 THE CAEE AND FEEDING OF CHILDREN 

air, clean bottles, and food given at the proper tem- 
perature, are all quite as important as the prepara- 
tion of the food; quiet, peaceful surroundings and 
absence of excitement are also essential to good di- 
gestion. In many cases in which children suffer fre- 
quently from indigestion and do not gain properly in 
weight, the fault is not with the food but with the 
care that the child receives. Both while the food is 
being taken and afterwards he should be left quite 
alone. This is particularly necessary with nervous 
children. 

COMMON MISTAKES IN MILK MODIFICATION AND 
INFANT FEEDING 

I. In using modifications made from top-milk, 
much confusion arises from the notion that top-milk 
is a single definite thing, whereas its composition 
depends upon a great variety of conditions and, un- 
less all these are known, it is impossible to tell how 
strong it is. Directions for the removal of top-milk 
should be explicitly followed, or the results will be 
very different from thote expected. 

II. In formulas calling for a certain number of 
ounces of top-milk, the mistake is made of removing 
only the number of ounces needed for the formula. 
The proper way is to remove the amount required to 



MISTAKES IX MILK MODIFICATION 103 

secure a top-milk of the desired strength and then to 
take of this the number of ounces needed in the 
formula. 

III. A rich Jersey milk is used as if it were 
ordinary milk. The formulas given in this book are 
chiefly calculated on the basis of a good average milk 
which contains about 4 per cent fat. Many persons 
have the idea that the richer the milk, the more rap- 
idly the child will gain in weight, and hence the 
superiority of such milk for infant feeding. While 
it is true that spme children taking a very rich milk 
may, for a time, gain rapidly in weight, yet sooner 
or later, serious disturbances of digestion are nearly 
always produced. 

IV. The food is increased too rapidly, particu- 
larly after some disturbance of digestion. If, in an 
infant three or four months old, an attack of some- 
what acute indigestion occurs, the food should sel- 
dom be given again in full strength before two weeks. 
The increase in the diet should be made very gradu- 
ally, the steps being made only one half those indi- 
cated in the series of formulas found on page 72. 
Otherwise it generally happens that the attack of 
indigestion is very much prolonged and much loss in 
weight occurs. 

V. When symptoms of indigestion occur, the food 
is not reduced rapidly enough. Indigestion usually 



104 THE CARE AND FEEDING OF CHILDEEN 

means that the organs are, for the time, "unequal to 
the work imposed. If the food is immediately re- 
duced by one half, the organs of digestion soon regain 
their power and the disturbance is short. In every 
case the amount of reduction should depend upon the 
degree of the disturbance. 

PEEPAEATIOIS' OF COWL'S MILK AT HOME 

What articles are required for the preparation of 
cow^s milJc at home? 

Feeding-bottles, rubber nipples, an eight-ounce 
graduated measuring glass, a glass or agate funnel, 
bottle brush, cotton, alcohol lamp or, better, a Bun- 
sen gas burner, a tall quart cup for warming bottles 
of milk, a pitcher for mixing the food, a wide-mouth 
bottle for boric acid and one for bicarbonate of soda, 
and a pasteurizer. Later, a double boiler for cooking 
cereals will be needed. 

What bottles are to he preferred? 

A cylindrical graduated bottle with a rather wide 
neck, so as to admit of easy washing, and one which 
contains no angles or corners. A single size holding 
eight ounces is quite sufficient for use during the first 
year. All complicated bottles are bad, being difficult 
to clean. One should have as many bottles in use as 
the child takes meals a day. 



PEEPAKATION OF COW^S MILK AT HOME 105 

How should bottles be cared for? 

As soon as they are emptied they should be rinsed 
with cold water and allowed to stand filled with water 
to which a little bicarbonate of soda has been added. 
Before the milk is put into them they should be 
thoroughly washed with a bottle brush and hot soap- 
suds and then placed for twenty minutes in boiling 
water. 

What sort of nipples should be used? 

Only simple straight nipples which slip over the 
neck of the bottle. Those with a rubber or glass 
tube are too complicated and very difficult to keep 
clean. Nipples made of black rubber are to be pre- 
ferred. The hole in the nipple should not be so large 
that the milk will run in a stream, but just large 
enough for it to drop rapidly when the bottle with 
the nipple attached is inverted. 

How should nipples be cared for? 

New nipples should be boiled for five minutes; 
but it is unnecessary to repeat this every day as they 
soon become so soft as to be almost useless. After 
using, nipples should . be carefully rinsed in cold 
water and kept in a covered glass containing a solu- 
tion of borax or boric acid. At least once a day 
they should be turned inside out and thoroughly 
washed with soap and water. 



106 THE CAEE AND FEEDING OF CHILDREN 



What sort of cotton should he used? 

The refined non-absorbent cotton is rather better 
for stoppering bottles, but the ordinary absorbent 
cotton will answer every purpose. 

Which is better, the Bunsen burner or the alco- 
hol lamp? 

If there is gas in the house, the Bunsen burner 
is greatly to be preferred, being cheaper, simp- 
ler, and much safer than the alcohol lamp. If the 
lamp is used, it should stand upon a table covered 
with a plate of zinc or tin, or upon a large tin 
tray. The French pattern of alcohol lamp is the 
best. 

Oive the directions for preparing the food ac- 
cording to any of the above formulas. 

The nurse's hands, bottles, tables, and all utensils 
should be scrupulously clean. First, dissolve the 
milk sugar in boiled water, filtering if necessary. 
Then add the milk and cream and lime-water, mix- 
ing the whole in a pitcher. A sufficient quantity of 
food for twenty-four hours is always to be prepared 
at one time. This is then divided into the number 
of feedings required for the day, each feeding being 
put in a separate bottle, and the bottle stoppered 
with cotton. The bottles should then be cooled rap- 



DIRECTIONS FOE FEEDING INFANTS 107 

idly by standing, first in tepid then in cold water, 
and afterward placed in an ice chest. If the milk 
is to be pasteurized or sterilized, this should precede 
the cooling. 

DIRECTIOISrS FOR FEEDIl^G II^FAIS^TS 

How should the hottle he prepared at feeding 
time ? 

It should be taken from the ice chest, and warmed 
by standing in warm water which is deep enough 
to cover the milk in the bottle; it should then be 
thoroughly shaken and the nipple adjusted ; the nurse 
should see that the hole in the nipple is not too large 
nor too small. 

How may the temperature of the milk he tested? 

Never by putting the nipple in the nurse's mouth. 
Before adjusting the nipple, a teaspoonful may be 
poured from the bottle and tasted, or a few drops 
may be poured through the nipple upon the inner 
surface of the wrist, where it should feel quite 
warm but never hot; or a thermometer may be 
placed in the water in which the bottle stands. A 
dairy thermometer should be used, and the tem- 
perature of the water should be between 98° and 
105° F. 



108 THE CARE AND FEEDING OF CHILDREN 

What is a simple contrivance for keeping the 
milk warm during feeding ? 

A small flannel bag with a draw string may be 
slipped over tbe bottle. 

In what position should an infant take its bottle? 

Por the first two or three months it is better, 
except at night, when it may be undesirable to take 
the infant from its crib, that it be held on the nnrse's 
arm during the feeding; later it may lie on its side 
in the crib provided the bottle is held by the nurse 
until it has been emptied; otherwise a young infant 
readily falls into the bad habit of alternately sucking 
and sleeping, and often will be an hour or more over 
its bottle. 

How much time should he allowed for one feed- 
ing? 

'Not more than twenty minutes. The bottle 
should then be taken away and not given until the 
next feeding time. Under no circumstances should 
an infant form the habit of sleeping with the nipple 
in its mouth. A sleepy infant should be kept awake 
by gentle shaking until the food is taken, or the bot- 
tle should be removed altogether. 

Should an infant be played with soon after feed- 
ing? 

On no account; such a thing frequently causes 



INTERVALS OF FEEDING 109 

vomiting and sometimes indigestion. After every 
feeding the infant should be allowed to lie quietly 
in its crib, and disturbed as little as possible, either 
by the nurse, the parents or visitors. 



IN^TERVALS OF FEEDING 

How often should a young haby he fed? 

During the first two weeks every two and a half 
hours by day and once at night, or eight times in the 
twenty-four hours. At two weeks the interval may be 
increased to three hours and seven feedings given in 
the twenty-four hours. 

Why should not a child be fed more frequently? 

It takes the stomach at least two hours to digest a 
feeding of cow's milk even when made as weak as 
that given during the first few weeks. Afterward, 
when the food is made stronger, more time is re- 
quired for digestion. If the meals are too near to- 
gether the second one is given before the first has been 
digested ; vomiting and indigestion may result. The 
meals should be far enough apart to give the stomach 
a little time for rest before the next feeding. 



110 THE CAEE AND FEEDING OF CHILDEEN 



Schedule for Feeding Healthy Infants during the 
First Year 



Age. 



2d to 7th day 

2d week 

3d to 9th week 

9th week to 5th mo . 
5th to 9th month . . . 
9th to 12th month.. 



Inter- 
val De- 


Night 
feed- 


No. of 
feed- 


^ tween 

meals 

by day. 


ings (10 
p. M. to 

7 A. M.) 


ings m 

24 
hours. 


Hours. 






2^ 
2H 
3 


1 

1 
1 


8 
8 
7 


3 


1 


7 


3 





6 


4 





5 



Quantity 
for one 
feeding 



Ounces* 

1 -2 

l>^-3 

3 -5 

4 -6 

5 -7J^ 
7 -9 



Quantity 

for 
24 hours. 



Ounces. 

8-16 
12-24 
21-35 

28-42 
30-45 
35-45 



This schedule gives the averages for healthy chil- 
dren. The smaller quantities are those required by 
small children whose digestion is not very vigorous. 
The larger quantities are those required by large 
children with strong digestion; in very few cases 
will it be advisable to go above these figures. 

The interval is reckoned from the beginning of 
one feeding to the beginning of the next one. 



When should the interval between the feedings 
he lengthened? 

When there is gastric indigestion as shown by 
habitual vomiting or the regurgitation of food long 
after the bottle is finished ; also when the appetite is 



EEGULAEITY IN FEEDHSTG 111 

very poor so that the infant regularly leaves some 
of its food. 

When should the interval between the feedings 
he^ shortened? 

This is done much too frequently; it is rarely 
advisable to feed any infant, except one seriously ill, 
oftener than the time put down in the schedule. 

EEGULAEITY IIT FEEDIITG 

How can a haby he taught to he regular in its 
hahits of eating and sleeping? 

By always feeding at regular intervals and put- 
ting to sleep at exactly the same time every day and 
evening. 

When should regular training he hegun? 
During the first week of life. 

Should a hahy he waTcened to he nursed or fed if 
sleeping quietly? 

Yes, for a few days. This will not be required 
long, for with regular feeding an infant soon wakes 
regularly for its meal, almost upon the minute. 

Should regularity in feeding he Jcept up at night 
as well as during the day? 

Only up to nine or ten o'clock ; after that time a 
baby should be allowed to sleep as long as it will. 



112 THE CAKE AND FEEDING OP CHILDKEN 

At what age may a well hahy go without food 
from 10 p. M. to 6 or 7 a. m. f 

Usually at four months, and always at five or six 
months, liight feeding is one of the most frequent 
causes of wakefulness and disturbed sleep. 



STERILIZED MILK 

What is meant hy sterilizing milk? 

Heating milk for the purpose of destroying 

germs. 

Does all cows' milh contain germs? 

Yes; even when handled most carefully, milk 
contains many germs; but when carelessly handled, 
and in summer, the number is enormous. While 
most of these are harmless or cause only the souring 
of milk, others are occasionally present which may 
produce serious diseases such as typhoid fever, diph- 
theria, scarlet fever, cholera, tuberculosis, and many 
forms of diarrhoea. 

Under what circumstances is it necessary to ster- 
ilize milh? 

1. In warm weather when it cannot be obtained 
fresh; hence always in cities and towns during the 
summer. 



STEEILIZED MILK 113 

2. When one cannot be certain that the cows are 
healthy, or that the milk has been carefully handled. 

3. When the milk is to be kept for any consider- 
able time (i. e., over twenty-four hours), especially 
if no ice can be had. 

4. During epidemics of typhoid or scarlet fever, 
sore throat, diphtheria, or any form of diarrhoea. 

What are the two methods of heating millc? 

The first is knovni as sterilizing, in which the 
milk is heated to 212° F. for one hour or one hour 
and a half; the second is known as pasteurizing, in 
which the milk is heated to 155° or 160° F. for 
thirty minutes. A temperature of 155° F. continued 
for thirty minutes is sufficient to kill the germs of the 
diseases above referred to. 

Will millc which has heen thus treated heep in- 
definitely? 

No; for although all the living germs may be 
killed, there are many undeveloped germs, or spores, 
which are not destroyed, and which soon grow into 
living germs. Milk heated to 212° F. for an hour 
will often keep upon ice for two or three weeks ; that 
heated to 155° F. should be used within 24 hours. 

Is milk which has heen sterilized always a safe 
food? 

No; for the reason that the milk may be so old, 



114 THE CAKE AND FEEDING OF CHILDREN 

SO dirty, and so contaminated before sterilizing that 
it may be still unfit for infant feeding, though it 
contains no living germs. 

Is cow's milk rendered more digestible hy being 
heated in this way? 

For most infants sterilizing milk does not improve 
its digestibility, but there are some v^ho certainly do 
better upon boiled or sterilized milk. Sterilized 
milk should be modified for infant feeding in the 
same way as milk which has not been heated. 

Is milk in any way injured by heating to 212^ F. 
for an hour? 

Milk is rendered more constipating, and for some 
children its nutritive properties are injured, so that 
it may cause scur^'^y ; this, however, is not likely un- 
less it is continued as the sole food for a long period. 
These objections are of so much importance that this 
plan of heating milk is not to be recommended for 
general use. Raw milk and sterilized milk are really 
different products; each has its advantages and its 
drawbacks. 

When is it advantageous to heat milk to 212^ F. ? 

For use upon long journeys, such as crossing the 
ocean. Milk should then be heated for one hour 
upon two successive days, without removing the stop- 
pers from the bottles. 



STERILIZED MILK 115 

Is milk in any way injured by heating at 155^ F, 
for thirty minutes? 

This point is not yet definitely settled. Such 
heating does not affect the taste of milk and does 
not render it more constipating. The unfavourable 
effects, if there are any, are so slight that they need 
not deter one from the use of pasteurized milk, even 
for long periods. The preference, however, for gen- 
eral use should be given to milk which is so clean and 
so fresh as not to require any heating; but only the 
cleanest and freshest milk can be given raw, certainly 
during warm weather. 

Hoiv should milk he pasteurized? 

A convenient form of apparatus is that knovni 
as Freeman's pasteurizer ^ ; another is the Walker- 
Gordon pasteurizer.^ 

Hoiv should milk he cooled after pasteurizing? 

Always by placing the bottles in cold water, so 
as to cool them rapidly ; never by letting them stand 
at the temperature of the room, or by placing them, 
when warm, in an ice box. 

Why is this precaution necessary? 

Cooling in the air or in an ice box requires from 

^This can be obtained at 411 West Fifty-ninth Street, New 
York, with bottles and full directions; a tin one, at a^ cost of 
$3.50, and a copper one, which is much more durable, for $7.00. 

2 Obtained at the same prices from any of the Walker-Gordon 
milk laboratories. 



116 THE CARE AND FEEDING OF CHILDREN 

two to four hoiirSj and during that time a great many 
of the undeveloped germs may mature and greatly 
injure the keeping properties of the milk. In the 
cold water milk can be cooled in from ten to twenty 
minutes if the water is frequently changed, or if ice 
is added to the water. 



Is it tetter to rely upon the pasteurization of 
milk at home or to purchase that which has been 
pasteurized before delivery ? 

The home pasteurization is by all means to be 
preferred. Considerable danger may lurk in com- 
mercially pasteurized milk because of the false sense 
of security. For safety several things are necessary : 
The milk should be reasonably clean before pasteuri- 
zation; the apparatus, the bottles or other utensils 
containing milk should be carefully sterilized and 
the whole process carried on with the most scrupulous 
care and cleanliness. Since pasteurization kills 
chiefly the bacteria which cause milk to sour, other 
germs, the spores of which are not killed by such 
heating, may develop rapidly unless the milk is kept 
cold, and though it may not turn sour it may contain 
immense numbers of germs when it is delivered or 
used. It should be kept carefully iced and used 
within twenty-four hours after heating. 



PEPTONIZED MILK 117 

MODIFIED MILK OF THE MILK LABORATORIES 

What is ''modified miW of the milk labora- 
tories? 

It is milk containing definite proportions of the 
fat, sugar, proteids, etc., put up usually according 
to the prescription of a physician, who indicates how 
much of the different elements he desires. The most 
reliable are the laboratories of the Walker-Gordon 
Company, which has branches in most of the large 
cities of the United States. 

This is an excellent method of having milk pre- 
pared, since it can be done with greater care and 
cleanliness than are possible in most homes. It is 
besides a great convenience if circumstances make it 
impossible to prepare the milk properly at home. 

The laboratory should be used for infant feed- 
ing only by one who is somewhat familiar with this 
method of ordering milk. 

PEPTONIZED MILK 

What is peptonized milk ? 

Milk in which the proteids (curd) have been par- 
tially digested. 

Eow is this accomplished? 

By the action of a peptonizing powder which is 
composed of a digestive agent known as the extractum 
pancreatis and bicarbonate of soda, which is added 



lis THE CARE AND FEEDING OF CHILDEEN 

to the plain or diluted milk. This is sold in tubes 
or in tablets, and it is the active ingredient of the 
peptogenic milk powder. 

Since it is infrequent for the proteids of milk to 
be the cause of indigestion, peptonizing milk has 
only a limited use, chiefly in cases of acute illness. 

CONDENSED MILK 

What is condensed milk ? 

Fresh milk which has been sterilized and then 
some of the water evaporated until one part repre- 
sents about two and a half parts of the original 
milk. The canned condensed milk usually has cane 
sugar added in the proportion of about seven ounces 
to one pint. 

Condensed milk is also sold fresh and in cans 
without any addition of cane sugar. To distinguish 
it from the usual variety this is sometimes called 
simply ^^evaporated'' milk. The Peerless brand is 
perhaps the most reliable. It is about the same 
strength and requires the same dilution as the usual 
condensed milk. 

Hoiu should condensed milk he used? 

For an infant three or four months old with 
symptoms of indigestion, it should at first be di- 
luted with 16 parts of boiled water, or, sometimes 
preferably, with barley-water. With improvement 



CONDENSED MILK 11& 

in the symptoms the dilution may be 1 to 14, 1 to 12, 

I to 10, and 1 to 8, these changes being gradually 
made. The intervals between feedings and the quan- 
tities for one feeding are given on page 110. 

The ^^evaporated'^ milk requires the same addi- 
tion of carbohydrates (sugar and starch) as does 
plain milk. The total amount of sugar added should 
be about one ounce to twenty ounces of the food pre- 
pared. The sugar may be milk sugar, maltose or 
cane sugar, often advantageously some of each. The 
starch may be given in the form of barley, wheat, or 
oat gruel, not more than eight or ten ounces in the 
daily food. 

Is condensed milk or ''evaporated" milk more 
easily digested than modified plain milk or pasteur- 
ized milk? 

By some especially delicate infants it appears to 
be, and may be tried where other forms of milk do 
not agree. 

How long should condensed milk he continued? 

In most cases it should be used as the sole food 
for a month or two only. Afterward, one feeding a 
day of a weak formula of modified milk (e. g., No. 

II or III Whole Milk Series, page 79) may be given; 
later two feedings, and thus gradually the number 
of modified milk feedings is increased until the child 
is taking only modified milk. 



120 THE CAEE AND FEEDING OF CHILDREN 

Condensed milk is not to be recommended as a 
permanent food where good fresh cow's milk can be 
obtained. 

Children reared npon it often gain rapidly in 
weight, yet have as a rule but little resistance. They 
are very prone to develop rickets and sometimes 
scurvy. 



BUTTERMILK 

What are the advantages of buttermilk in infant 
feeding? 

Chiefly that the fat has been removed, this ele- 
ment being the one with which many children have 
difficulty; there are, besides, some changes in the 
sugar and proteids due to the slight fermentation 
which takes place in the souring of the milk. 

When is buttermilk to be employed? 
It is useful in many cases of severe chronic in- 
digestion and in some cases of acute indigestion. 

How is it prepared and fed? 

Fresh buttermilk may be purchased at many 
dairies ; or skimmed milk may be fermented by vari- 
ous ferments sold in tablet form, such as ^^lactone/' 



CASEIN MILK 121 



^^bulgara/' etc. ; or a specially prepared buttermilk 
may be purchased from one of the milk laboratories 
known as ^^lactic acid milk," or elsewhere under a 
great variety of other names. It may be fed as pre^ 
pared or diluted with plain water or barley-water. 



CASEIN MILK 

What is '^casein miW? 

This term has been given to a form of modified 
milk extensively used in Germany, in which much of 
the milk sugar has been removed and the casein in- 
creased. 

When is this useful ? 

Chiefly in cases of indigestion, acute or chronic, 
accompanied by diarrhoea with thin and often sour 
stools. 

How is casein milk prepared? 

One quart of whole milk is coagulated by rennet 
(see page 154), the whey is then strained off and 
thrown away. The curd is carefully rubbed through 
a fine wire sieve with the addition of one pint of 
buttermilk. Enough water is then added to bring 
the whole up to one quart. 



122 THE CARE AND FEEDING OF CHILDEEN 

How is it fed? 

Eor older infants it is given as prepared above; 
for younger and more delicate ones it is at first 
diluted with an equal volume of water, afterwards 
with less water. It may be continued for a week 
or ten days, or until the symptoms improve; then 
sugar is added, preferably maltose. Later the infant 
is given formulas from whole milk (page 79). 



FEEDING DUEING THE SECOND YEAE 

If the general directions given in previous pages 
have been followed, the infant will be taking at 
eleven or twelve months five meals, at four-hour in- 
tervals, 8 or 9 ounces at a time. Of this, about two- 
thirds should be milk and one-third gruel — i. e., 
Formula III, page 76, or Formula X, page 79. Be- 
sides this he will probably be receiving orange juice, 
one or two ounces a day, and beef juice, one ounce 
a day. 

How many meals are required in the second year? 

Usually five meals. Some children will sleep 
from 6 p. M. to 6 a. m. without waking, but unless 
there is a feeding at 10 p. m. children are apt to 
wake very early in the morning. 



FEEDING DUEING THE SECOND YEAK 123 

Should each feeding he prepared at the time 
given, or all feedings at one time, as during the first 
year? 

During the second and third years it is better 
to prepare the milk for the entire day at one time. 

Later, when only plain milk is nsed, the quanti- 
ties needed for the different feedings should be put 
into separate bottles, which then may be pasteur- 
ized or not as is necessary. In this way the 
different feedings are kept separate, and the day's 
supply of milk is not disturbed every time the child 
is fed, as otherwise is unavoidable. The food should 
be prepared as soon as possible after the daily milk 
supply is delivered in the morning. 

What changes may now he made in the food? 

The proportion of milk in the food may be in- 
creased ; the lime water and milk sugar may be grad- 
ually omitted ; broth may be added to one of the feed- 
ings. The child should begin to take at least part 
of his food from the cup. 

Give a proper diet for an average healthy child 
of twelve months, 

6.30 A. M. Milk, six to seven ounces; diluted with barley or oat 
gruel, two to three ounces; after the thirteenth 
month, taken from a cup. 
9 A. M. Orange juice, one to two ounces. 



124 THE CARE AND FEEDING OF CHILDREN 

10 A. M. Milk, two parts; oatmeal or barley gruel, one part; 
from ten to twelve ounces in all may be al- 
lowed; it should be given from a cup/ 
2 p. M. Beef juice, one to two ounces; 

or, the white of one egg, slightly cooked; later 
the entire egg; 

or, mutton or chicken broth, four to six ounces. 
Milk and gruel in proportions above given, four to 
six ounces. 
6 p. M. Same as at 10 a. m. 
10 p. M. Same as at 6.30 a. m., except that the milk may be 

given from the bottle. ^ 

How long may this schedule he followed? 

Usually until the fourteenth or fifteenth month. 
After this time the cereals may be given much 
thicker and fed from a spoon. ^ 

May any other fruit juices he given at this 
period? 

Orange juice is the best; next to this the juice- 
of fresh ripe peaches, red raspberries or strawberries. 
All these should be strained very carefully through 
muslin to make sure that the child gets none of the 
pulp or seedsj either of which may cause serious dis- | 
turbance. Of the orange or peach juice, from one to 
four tablespoonfuls may be allowed at one time; of 
the others about half the quantity. The fruit juice 
is best given one hour before the second feeding. 

When should a child he iveaned from its hottle? 
Most children can and should be taught to take 



) 



FEEDING DURING THE SECOND YEAR 125 

their food from the cup or spoon by the time they 
are thirteen months old ; but it is convenient to give 
the 10 p. M. feeding from the bottle during the 
greater part of the second year (see page 55). 

Give a proper diet for an average child from the 
fourteenth to the eighteenth month. 

The bottle should not be given except at night. 
Cereals may now form an important part of the 
diet. They should be very thoroughly cooked^ usu- 
ally for three hours, and strained. 

The daily schedule should be about as follows : 

6 . 30 A. M. Milk, warmed, eight to ten ounces, given from a cup. 
9 A. M. Fruit juice, one to three ounces. 
10 A. M. Cereal: one, later two or three, tablespoonfuls of 
oatmeal, hominy or wheaten grits, cooked 
for at least three hours and strained; 
upon this from one to two ounces of thin 
cream, or milk and cream, with plenty 
of salt, but without sugar. 
Crisp dry toast, one piece; 
or, unsweetened zwieback; 

or, one Huntley and Palmer breakfast 
biscuit. 
Milk, warmed, six to eight ounces, from a cup. 
2 P. M. Beef juice, one to two ounces; and one egg (soft 
• boiled, poached or coddled); and boiled 

rice, one tablespoonful; 
or, broth (mutton or chicken), four ounces; 
one or two Huntley and Palmer breakfast 
biscuits, or zwieback; and (if most of the 
teeth are present) rare scraped meat, at 
first one teaspoonful, gradually increasing 
to one tablespoonful. 
Milk, four or five ounces. 



126 THE CAKE AND FEEDING OF CHILDREN 

6 p. M. Cereal: two tablespoonfuls of farina, cream of wheat 
or arrowroot, cooked for at least one half 
hour, with milk, plenty of salt, but with- 
out sugar. 
Milk, warmed, eight to ten ounces, given from a cup. 
10 P. M. Milk, warmed, eight to ten oimces, which may be 
given from a bottle. 

Give a proper diet for an average child from the 
eighteenth month to the end of the second year. 

The same order of meals as for the months just 
preceding should be followed. For most children 
milk at 10 p. m. is desirable. There are many, how- 
ever, who sleep regularly from 6 p. m. until 6 a. m. 
without food; for such the night feeding should, of 
course, not be insisted upon. 

The daily schedule should be about as follows : 

6.30 A. M. Milk, warmed, ten to twelve ounces, given from cup. 

9 A. M. Fruit juice, two to three ounces. 

10 A. M. Cereals: similar to those given from the fourteenth 

to the eighteenth month; they need not be 

( strained although they should be cooked 

and served in the same way. 

Crisp dry bread, zwieback, or Huntley and Palmer 

biscuits, without butter. 
Milk, warmed, one cup. 
2 P. M. Beef juice and one egg; 

or, broth and meat; care being taken that 
the meat is always rare and scraped or 
very finely divided; beefsteak, mutton 
chop, or roast beef may be given. 
Very stale bread, or two pieces of zwieback. 
Prune pulp or baked apple, one to two tablespoonfuls. 
Water; no milk. 



FEEDING DURING THE SECOND YEAR 127 

6 p. M. Cereal: farina, cream of wheat, or arrowroot, cooked 
for at least one half hour, with milk, 
plenty of salt, but without sugar. 
or, milk toast or stale bread and milk. 
10 P. M. If required, ten to twelve oimces of plain milk. 

What fruUs may he given at this period? 

If the child has a feeble digestion, only the fruit 
juices previously allowed; strong children may have 
in addition prune pulp, baked apple, and apple- 
sauce. The prune pulp is prepared by stewing the 
dried prunes without sugar until they are very soft, 
and removing all the skin by putting the fruit 
through a strainer; of this from one to two table- 
spoonfuls may be given at one time. The baked 
apple should be given without cream, and the apple- 
sauce should have very little sugar. 

How and when should water he given? 

Throughout the second year water should be 
given freely between the feedings, especially in warm 
weather; from one to three ounces may be given at 
one time, either from a spoon, a glass, or a bottle. 
The water should be boiled daily and then cooled. 
It should not be allowed to stand in the room, but 
fresh water should be put into the bottle each time. 



128 THE CARE AND FEEDING OF CHILDREN 



FEEDING DURING THE THIRD YEAR 

What changes may he made in the diet during 
the third year? 

The niglit feeding at 10 p. m. should be omitted. 
A greater quantity of solid food may be allowed, 
particularly at the mid-day meal. It is not advisable 
to begin potato and other vegetables until the age of 
two years is reached. Three regular meals should 
be given and milk once besides, either between the 
breakfast and dinner or dinner and supper, which- 
ever is the longer interval. Water should be allowed 
freely between meals. 

What would he a proper schedule for an average 
child during the third year? 

7.30 A. M. Cereal: cooked (preferably over niglit) for three 
hours, although a somewhat larger variety may 
be given than during the second year; given as 
before with milk or thin cream, salt, but very 
Httle sugar. 
Warm milk, one glass. 
A soft egg, poached, boiled or coddled. 
Bread, very stale or dry, one shce, with butter. 
10 A. M. Warm milk, one cup, with a cracker or piece of very 
stale bread and butter. 
2 P. M. Soup, four ounces; 

or, beef juice, two ounces. 
Meat: chop, steak, roast beef or lamb or chicken. 
A baked white potato; 
or, boiled rice or spaghetti; both cooked five hours. 



FEEDING DUEING THE THIRD YEAR 129 



Green vegetable : asparagus tips, string beans, peas, 

spinach; all to be cooked until very soft, and 

mashed, or preferably put through a sieve; at 

first, one to two teaspoonfuls. 

Dessert: cooked fruit — ^baked or stewed apple, 

stewed prunes. 
Water; no milk. 
6 P. M. Cereal: farina, cream of wheat, or arrowroot, cooked 
for at least one half hour, with plenty of salt, but 
without sugar; 
or, milk toast; 
or, bread and milk; 

or, stale or dry bread and butter and a glass of 
milk. 



PAET III 
THE DIET OF OLDER CHILDREN 



Ill 

THE DIET OF OLDER CHILDREN 

(FOURTH TO TENTH YEAR) 
Throughout this period the largest meal should 
always be in the middle of the day, and a light sup^ 
per given, very much like that described for the third 
year. During the first half of this period, milk may 
be allowed once either between breakfast and dinner 
or dinner and supper ; no other eating between meals 
should be permitted, but water should be allowed 
freely. 

MILK AITD CREAM 

What part of the diet should milk form during 
childhood? 

It should form a very important part; nothing 
can take its place. There are comparatively few 
children who cannot take and digest milk if it is 
properly fed. 

Why is .milk so advantageous? 
Because no food that we possess has so high a 
nutritive value as milk, for the amount of work re- 

133 



134 THE CAEE AND FEEDING OE CHILDREN 

quired of the organs of digestion. It is, therefore, 
peculiarly adapted to the diet of the child. 

What are the essential points in the use of milk? 

It should be clean and fresh, but not too rich. It 
is a mistake to select for any children the rich milk 
of a Jersey herd and use it as though it were an 
ordinary milk. For children who have difficulty in 
digesting milk, it should be somewhat diluted, i. e., 
one part of water to four parts of milk, or salt or 
bicarbonate of soda should be added. It is also im- 
portant not to give milk at meals when fruits, espe- 
cially sour fruits, are allowed. 

How much milk may advantageously he given? 

The average child with good digestion should 
take from one and one half pints to one quart of 
milk daily, this including not only what the child 
drinks but what is served upon cereals and in other 
ways. It is seldom wise to allow a child to take as 
much as two quarts daily, as a more mixed diet for 
most children is better. 

To ivhat extent may cream he used? 

Older children do not require so large a propor- 
tion of fat in their food as do infants, and the use 
of cream, especially very rich cream, often results in 
disturbances of digestion. The use of too much or 
too rich cream is a common cause of the coated 



THE DIET OF OLDER CHILDREN 135 

tongue, foul breatli and pale gray stools, often called 
"biliousness.'^ 

Is not cream useful in overcoming the constipa- 
tion of children? 

With infants it is valuable to a certain point, but 
witb older children only to a limited degree, and if 
such symptoms as those above described are present, 
cream should not be given. 



EGGS 

To what extent may eggs he used in the diet of 
this period? 

They form a most valuable food. It is important 
that they should be fresh and only slightly cooked, 
soft boiled, poached or coddled; fried eggs should 
not be given and omelets are objectionable. 

The finely grated yolk of a hard-boiled egg may 
be given with advantage to many infants even as 
young as five or six months. 

Is it not true that eggs often cause ''bilious- 
ness''? 

Very seldom, if fed as above advised. This is 
an old prejudice but has little basis in fact. 



136 THE CAEE AND FEEDING OF CHILDREN 

How often may eggs he given? 

Most children from four to ten years old will 
take one egg for breakfast and another for supper 
for an indefinite period with relish and benefit. 
There are, however^ some few who have a peculiar 
idiosyncrasy as regards eggs and cannot take them 
at alio 

MEAT AND FISH 

WTiat meats may he given to young children? 

The best are beefsteak, mutton-chop, roast beef, 
roast lamb, broiled chicken and certain delicate fish, 
such as shad or bass. 

What are the important points to he considered 
in giving meat to children? 

Most meats should be rare and either scraped oi^ 
very finely divided, as no child can be trusted to 
chew meat properly. Meats are best broiled or 
roasted, but should not be fried. 

How often should meat he given? 
At this period, only once a day, at the mid-day 
meal. 

Is not the excessive nervousness of many modern 
children due to the giving of meat, or at least aggra- 
vated hy its use ? 

There is little ground for such a belief, unless 



THE DIET OF OLDEE CHILDEEN 137 

an excessive amount of meat is given. Certainly 
cutting off meat from the diet of nervous children 
seldom produces any striking effect. 

What meats should be forbidden to young chil- 
dren? 

Ham, bacon, sausage, pork, liver, kidney, game 
and all dried and salted meats, also cod, mackerel 
and halibut ; all of these are best withheld until the 
child has passed the tenth year. 

Are not gravies beneficial and nutritious? 

The beef juice, or so-called ^^platter gravy," from 
a roast is exceedingly nutritious and desirable, but 
many of the thickened gravies are much less diges- 
tible and are too often given in excess ; only a small 
quantity should be allowed. They should not form 
an important part of the meal. 

VEGETABLES 

What vegetables may be used at this period? 

White potatoes may be given first. These should 
preferably be baked or boiled and mashed, but not 
fried. They should be served with beef juice or 
with cream rather than with butter. 

Of the green vegetables, the best are peas, spin- 
ach, asparagus tips, string beans, stewed celery, 
young beets, or carrots, and squash. Baked sweet 



138 THE CAEE AND FEEDING OF CHILDEEN 

potato, turnips, boiled onions and cauliflower, all 
well cooked, may be given after the sixth or seventh 
year in moderate amount. 

The principal trouble in the digestion of vege- 
tables is due to imperfect cooking. It is, in fact, 
almost impossible to cook them too much; they 
should also be very finely mashed. They form a 
valuable addition to the diet after three years, 
although the amount at first given should be small, 
one or two teaspoonfuls. They greatly aid in secur- 
ing regularity of the bowels. Because small par- 
ticles are seen in the stools, it is not to be inferred 
that they are causing disturbance and should, there- 
fore, be stopped, but only that they should be more 
thoroughly cooked and more finely divided before 
being given. 

Is it safe to use canned vegetables for chil- 
dren? 

Many of the best brands of canned vegetables are 
quite safe and some, such as peas and asparagus, 
can be used with advantage. They are frequently 
better than stale green vegetables often sold in the 
markets. 

What vegetables should not be given to young 
children? 

ISTone of those which are eaten raw, such as 



THE DIET OF OLDER CHILDREN 139 

celery, radishes, onions, cucumbers, tomatoes or let- 
tuce. Certain others, even when well cooked, should 
not be allowed; as corn, lima beans, cabbage, egg 
plant. None of these should be given until a child 
has passed the age of ten years. 

Are vegetable salads to he given? 

As a rule salads of all kinds should be omitted 
until a child has passed the tenth year. Salads are 
difficult to digest and a cause of much disturbance 
in children of all ages. 

CEREALS 

What are the most important points in selecting 
and preparing cereals? 

The important things are that they are properly 
cooked and not used in excess. The dry or ready-to- 
serve cereals should not be chosen for children, nor 
should a child, because he is fond of cereals, be 
allowed to make his entire meal of them, taking 
two or three saucerfuls at a feeding. 

Many of the partially cooked preparations of 
oatmeal and wheat are excellent, but should be cooked 
for a much longer time than is stated upon the pack- 
age, usually three or four times as long. Digesti- 
bility is chiefly a matter of proper cooking. Most of 
the grains, — oatmeal, hominy, rice, wheaten grits, — ■ 



140 THE CAKE AND FEEDING OE CHILDKEN 

require at least three hours' cooking in a double 
boiler in order to be easily digested. The prepared 
flours, — corn starch, arrowroot, barley, — should be 
cooked at least twenty minutes. The ^^fireless cooker'' 
is a very useful contrivance for cooking cereals, l^one 
of the ready-to-serve cereals are to be recommended 
for children. 

How are cereals to he given? 

Usually with milk or a mixture of milk and 
cream; always with an abundance of salt and with 
very little or no sugar, one half teaspoonful on a 
saucerful of cereal should be the limit. 

Cereals should not be served with sirups or but- 
ter and sugar. 

BROTHS AND SOUPS 

What broths and soups are to be recommended? 

Meat broths are generally to be preferred to 
vegetable broths, — mutton or chicken being usually 
most liked by children. I^early all plain broths n\ay 
be given. Those thickened with rice, barley or corn 
starch form a useful variety, especially with the 
addition of milk. 

Vegetable purees of peas, spinach, celery or 
asparagus may be used for children over seven years 
old. Tomato soup should not be given to young 
children. 



THE DIET OF OLDEE CHILDREN 141 

BREAD^ CRACKERS AND CAKES 

What forms of hreadstuffs are test suited to 
young children? 

Fresh bread should not be given, but stale bread 
cut thin and freshly dried in the oven until it is 
crisp is very useful, also zv^ieback, the unsweetened 
being preferred. Oatmeal, graham or gluten crack- 
ers, and the Huntley and Palmer breakfast biscuits, 
stale rolls, or corn bread which has been split and 
toasted or dried till crisp, form a sufficient variety 
for most children. 

What hreadstuffs should he forhidden? 

All hot breads, all fresh rolls, all buckwheat and 
other griddle cakes, all fresh sweet cakes, especially 
those covered with icing and those containing dried 
fruits. A stale lady-finger or piece of sponge cake 
is about as far in the matter of cakes as it is wise to 
go with children up to seven or eight years old. 

DESSERTS 

What desserts may he given to young children? 

Mistakes are more often made here than in any 
other part of the child's diet. Up to six or seven 
years, only junket, plain rice pudding without 



142 THE CAEE AND FEEDING OF CHILDKEN 

raisins, plain baked custard and, not more than once 
a week, a small amount of ice cream. 

What should he especially forbidden? 

All pies, tarts and pastry of every description, 
jam, sirups and preserved fruits; nuts, candy and 
dried fruits. 

Does ''a little'^ do any harm? 

Yes, in that it develops a taste for this sort of 
food, after which plainer food is taken with less 
relish. Besides the ^^ittle'^ is very apt soon to be- 
come a good deal. 

Does not the chiWs instinctive craving for 
sweets indicate his need of them? 

That a child likes or craves sweets is the usual 
excuse of an indulgent parent. Every child likes 
his own way, but that is no reason why he should 
not be trained to obedience and self-control ; a child's 
fondness for sweets can hardly be considered a nor- 
mal instinct. As a matter of fact, supported by 
everyday experience, no causes are productive of 
more disorders of digestion than the free indulgence 
in desserts and sweets by young children. It is a 
constantly increasing tendency, not easily controlled 
as a child grows older; and in early childhood, the 
only safe rule is to give none at all. 



THE DIET OF OLDER CHILDREN 143 

FRUITS 

Are fruits an essential or important part of the 
diet? 

They are a very important part and should be 
begun in infancy. They are particularly useful for 
the effect they have upon the bowels. It is important 
that they should be selected with care and given with 
much discretion, especially in cities. In the country, 
where fruit is absolutely fresh, a somewhat greater 
latitude may be allowed than is given below. 

What fruits may safely he given to children up 
to five years old? 

As a general rule, only cooked fruits and the 
juices of fresh fruits. 

What fruit juices may he used? 

That from sweet oranges is the best, but the 
fresh juice of grape fruit, peaches, strawberries and 
raspberries may also be used. 

What cooked fruits may he given? 
Stewed or baked apples, prunes, pears, peaches 
and apricots. 

What raw fruits are to he particularly avoided 
with young children? 

The pulp of oranges or grape fruit, also cherries, 
berries, bananas and pineapple. 



144 THE CAEE AND FEEDING OF CHILDKEN 

What precautions should he emphasized regard- 
ing the use of fruits? 

That they should be used with greater care in 
hot weather and with children who are prone to 
attacks of intestinal indigestion. 

What symptoms indicate that fruits should he 
avoided? 

A tendency to looseness of the bowels with the 
discharge of mucus, or frequent attacks of abdominal 
pain or stomach-ache. 

Is there any special choice of meals at which 
fruit should he given? 

The fruit juice given early in the mornings upon 
an empty stomach, works more actively upon the 
bowels than if it is given later in the day. 

It is not, as a rule, wise to give cream or milk 
with sour fruits. Usually the fruit is best given at 
the mid-day meal, as a dessert, at a time when no 
milk is taken. It is in all cases important that the 
quantity of fruit should be moderate. 

What hesides water and milk should a child he 
allowed to drink and what should he forhidden? 

Tea, coffee, wine, beer and cider in all quantities 
and in all forms should be forbidden to young chil- 
dren below puberty. Cocoa which is made very 
weak, i. e., almost all milk, is often useful as a hot 



INDIGESTION IN OLDER CHILDREN 145 

drink. Lemonade, soda-water, etc., should if pos- 
sible be deferred until the tenth year. A free in- 
dulgence in things of this kind should never be per- 
mitted with children of seven or eight years. 



INDIGESTION IN OLDER CHILDREN 

What are the different ways m which indigestion 
shows itself in children? 

First, in acute disturbances which last for a few 
days only; and, secondly, in chronic disturbances 
which may continue for weeks or months. 

Which of the two forms of indigestion is more 
likely to impair seriously the health of the child? 

Chronic indigestion; for since the cause is not 
recognized it often goes on for months and even 
years unchecked. 

What are the symptoms of acute indigestion? 

These are familiar and easily recognized. They 
are vomiting, pain, undigested movements from the 
bowels, often fever and considerable prostration. 

Such attacks are usually traceable to their 
proper cause, the removal of which is followed by 
prompt recovery. 



146 THE CAEE AND FEEDING OF CHILDREN 

What are the common causes of acute indir 
gestion? 

This is frequently due to overeating, to indul- 
gence in some special article of improper food, or to 
eating heartily when overtired. Acute indigestion 
often marks the beginning of some acute general 
illness. 

How should acute indigestion he managed? 

One should bear in mind that for the time being 
the digestive organs have stopped work altogether. 
The important thing, therefore, is to clear out from 
the intestines all undigested food by some active 
cathartic, such as castor oil. The stomach has 
usually emptied itself by vomiting. All food should 
be stopped for from twelve to thirty-six hours, 
according to the severity of the attack, only water 
being given. 

At the end of this time is it safe to begin with 
the former diet? 

'No; for such a procedure is almost certain to 
cause another attack of indigestion. At first only 
broth, thin gruel, very greatly diluted milk, or whey 
should be given. The diet may be very slowly but 
gradually increased as the child's appetite and 
digestion improve, but in most cases a week or ten 
days should elapse before the full diet is resumed. 



INDIGESTION IN OLDEK CHILDEEN 147 

What are the symptoms of chronic indigestion? 

These, although familiar, are not so easily dis- 
tinguished and are very often attributed to the 
wrong cause. There are usually general symptoms 
such as indisposition, disturbed sleep, grinding of 
the teeth, fretfulness, languor, loss of weight and 
anaemia. There are besides local symptoms: flat- 
ulence, abdominal pain, abdominal distention, con- 
stipation, or looseness of the bowels with mucus in 
the stools, foul breath, coated tongue, loss of appe- 
tite, or an abnormal, capricious appetite. Such 
symptoms are often wrongly ascribed to intestinal 
worms. 

What are the common causes of chronic indi- 
gestion? 

This is generally the result of a bad system of 
feeding, either the prolonged use of improper food 
or of improper methods of feeding. 

Examples of bad methods of feeding are, coaxing 
or forcing to eat, rapid eating with insufficient mas- 
tication, eating between meals, allowing a child to 
have his own way in selecting his food, as when he 
lives largely upon a single article of diet. Things to 
be considered under the head of improper food are, 
indulgence in sweets, desserts, etc., the use of imper- 
fectly cooked foods, especially cereals and vege- 
tables, and of raw or stale fruits. 



148 THE CARE AND FEEDING OF CHILDREN 

75 it not true that a diet or a special article 
of food which does not make a child ill is proof 
that such a diet or such a food is proper for a 
child? 

By no means; with many people the only guide 
in feeding children is that the article in question 
did not make the children sick, therefore it is allow- 
able. This is a very bad principle. A better one 
is to adopt such a diet as will nourish the child's 
body with the least possible tax upon his digestive 
organs; in other words, to exclude articles which 
experience has shown to be injurious to most chil- 
dren. 

How should chronic indigestion he managed? 

This is a much more difficult matter than the 
treatment of acute indigestion, for, as it is usually 
the result of the prolonged use of improper food or 
of an improper method of feeding, a cure can be 
accomplished only by a discovery and removal of 
the cause. 

Is chronic indigestion curable? 

In the vast majority of cases it is so, but only 
by faithfully observing for a long period the rules 
for simple feeding laid dovtm elsewhere. One of 
the greatest difficulties in the way of recovery is 
that parents and nurses are unwilling to follow a 



GENEEAL EXILES TO BE OBSEEVED IN FEEDINQ 149 

restricted diet long enough to secure a complete 
cure, or to change radically their methods of feed- 
ing, but expect the child to recover by simply taking 
medicine. 

For how long a 'period is it necessary to continue 
very careful feeding? 

In any case it must be done for several months ; 
with most children for two or three years; with 
some, throughout childhood, for with them the 
slightest deviation from established rules is sure to 
provoke a relapse. 

Is not medicine useful? 

It is undoubtedly of assistance for the relief of 
some symptoms, but the essential thing is proper 
feeding, without which nothing permanent can be 
accomplished. 



GENERAL RULES TO BE OBSERVED IN 
FEEDING 

Bad habits of eating are readily acquired but 
difficult to break. 

Young children should not be allowed to play 
with their food, nor should the habit be formed of 
amusing or diverting them while eating, because by 
these means more food is taken. 



150 THE CARE AND FEEDING OF CHILDREN 

Older children should not be permitted to make 
an entire meal of one thing, no matter how proper 
this may be. 

Children who are allowed to have their own 
way in matters of eating are very likely to be badly 
trained in other respects; while those who have 
been properly trained in their eating can usually 
be easily trained to do anything else that is im- 
portant. 

Learning to eat proper things in a proper way 
forms, therefore, a large part of a child's early edu- 
cation. If careful training in these matters is begun 
at the outset and continued, the results will well 
repay the time and effort required. 

Whether the child feeds himself or is fed by the 
nurse, the following rules should be observed: 

1. Food at regular hours only; nothing between 
meals. 

2. Plenty of time should be taken. On no ac- 
count should the child bolt his food. 

3. The child must be taught to chew his food. 
Yet no matter how much pains are taken in this 
respect, mastication is very imperfectly done by all 
children; hence up to the seventh year at least, all 
meats should be very finely cut, all vegetables 
mashed to a pulp, and all grains cooked very soft. 

4. Children should not be continually urged to 



GENEBAL EXILES TO BE OBSERVED IN FEEDINa 151 

eat if they are disinclined to do so at their regular 
hours of feeding, or if the appetite is habitually 
poor, and under no circumstances should a child be 
forced to eat. 

5. Indigestible food should never be given to 
tempt the appetite when the ordinary simple food is 
refused; food should not be allowed between meals 
because it is refused at meal-time. 

6. One serious objection to allowing young chil- 
dren highly seasoned food, entrees, jellies, pastry, 
sweets, etc., even in such small amounts as not to 
upset the digestion, is that children thus indulged 
soon lose appetite for the simple food which pre- 
viously was taken with relish. 

7. If there is any important article of a simple 
diet such as milk, meat, cereals, or vegetables, which 
a child habitually refuses, this should always be 
given first at the meal and other food withheld 
until it is disposed of. Children so readily form 
habits of eating only certain things and refusing 
others that such an inclination should be checked 
early. 

8. If an infant refuses its food altogether, or 
takes less than usual, the food should be examined 
to see if this is right. Then the mouth should be 
inspected to see if it is sore. If neither of these 
things is the cause, the food should be taken away 



152 THE CAEE AND FEEDING OF CHILDEEN 

and not offered again until the next feeding time 
oomes. 

9. In any acute illness the amount of food should 
be much reduced and the food made more dilute 
than usual. If there is fever, no solid food should 
be given. If the child is already upon a milk diet, 
this should be diluted. 

10. In very hot weather the same rules hold, to 
give less food, particularly less solid food, and more 
water. 

FOOD FORMULAS 

Beef Juice. — One pound of rare round steak^ 
cut thick, slightly broiled, and the juice pressed out 
by a lemon-squeezer, or, better, a meat-press. From 
two to four ounces of juice can generally be ob- 
tained. This, seasoned with salt, may be given 
cold, or warmed by placing the cup which holds it 
in warm water. It should not be heated sufficiently 
to coagulate the albumin which is in solution, and 
which then appears as flakes of meat floating in 
the fluid. 

Beef Juice hy the Cold Process. — One pound of 
finely chopped round steak, six ounces of cold water, 
a pinch of salt; place in a covered jar and stand on 
ice or in a cold place, five or six hours or overnight. 
It is well to shake occasionally. This is now 



^OOD FORMULAS 153 

strained and all the juice squeezed out by placing 
the meat in coarse muslin and twisting it very hard. 
It is then seasoned and fed like the above. 

Beef juice so made is not quite as palatable as 
that prepared from broiled steak, but it is even more 
nutritious, and is more economical, as fully twice as 
much juice can be obtained from a given quantity of 
meat. Beef juice prepared in either of these 
ways is greatly to be preferred to the beef extracts 
sold. 

Mutton Broth. — One pound of finely chopped 
lean mutton, including some of the bone, one pint 
cold water, pinch of salt. Cook for three hours over 
a slow fire down to half a pint, adding water if 
necessary; strain through muslin, and when cold 
carefully remove the fat, adding more salt if re- 
quired. It may be fed warm, or cold in the form 
of a jelly. 

A very nutritious and delicious broth is made by 
thickening this with cornstarch or arrowroot, cook- 
ing for ten minutes and then adding three ounces of 
milk, or one ounce of thin cream, to a half pint of 
broth. 

Chicken, Veal, and Beef Broths, — These are 
made and used in precisely the same manner as mut- 
ton broth. 



154 THE CAEE AND FEEDING OF CHILDEEN 

■ ' ' " ■ 

Scraped Beef or Meat Pulp. — ^A piece of rare 
round or sirloin steak, the outer part having been 
cut away, is scraped or shredded with a knife; one 
teaspoonful to one tablespoonful may be given, well 
salted, to a child of eighteen months. Scraping is 
much better than cutting the meat fine. 

For this on a large scale, as in institutions, a 
Hamburg-steak cutter may be employed. 

Junket, or Curds and Whey. — One pint of fresh 
cow's milk, warmed; pinch of salt; a tablespoonful 
of granulated sugar; add two teaspoonfuls of Fair- 
child's essence of pepsin, or liquid rennet, or one 
junket tablet dissolved in water ; stir for a moment, 
and then allow it to stand at the temperature of the 
room for twenty minutes, or until firmly coagu- 
lated; place in the ice box until thoroughly cold. 
For older children this may be seasoned with grated 
nutmeg. 

Whey. — The coagulated milk prepared as above 
is broken up with a fork and the whey strained off 
through muslin. If some stimulant is desired, 
sherry wine, in the proportion of one part to twelve, 
may be added. Whey is useful in many cases of 
acute indigestion. 

Barley Water. — One level tablespoonful of Rob- 
inson's patent barley, or the prepared barley flour 



FOOD FOKMULAS 155 

of the Health Food Company^ is thoroughly blend- 
ed with a little cold water and added, stirring, to 
ten ounces of boiling water containing a pinch of 
salt. This is cooked for thirty minutes in a 
double boiler and then strained. Enough boiled 
water should then be added to bring the whole up to 
one pint. 

Barley Gruel or Barley Jelly. — This is made in 
the same manner as the above but from two to four 
level tablespoonfuls of the flour are used according 
to the thickness of the gruel desired. 

Either barley water or barley jelly may be made 
from the grains. Eor barley water, use one heaping 
tablespoonful of pearl barley which has been soaked 
four or five hours, or overnight, one pint of water, 
a pinch of salt. This is boiled steadily for four 
hours, adding water from time to time to keep the 
quantity up to one pint. It is then strained through 
muslin. 

For barley gruel or barley jelly use from two to 
four tablespoonfuls of pearl barley. 

Rice, Wheat, or Oat Water. — These are made 
from rice, wheat, or oat flour exactly as barley 
water, above described. Like the barley water they 
may also be made from the grains, using the same 
proportions. 



156 THE CARE AND FEEDING OE CHILDREN 

Gruel or Jelly from Bice, Wheat, or Oats, — 
These are made from the flours or grains as has been 
described for barley gruel. 

For the wheat preparations, ordinary wheat 
flour may be used or Hubbell's prepared wheat 
flour ; or wheaten grits may be employed. 

For the rice preparations the ordinary rice 
grains or rice flour may be used. 

For the oat preparations, either the oat flour of 
the Health Food Company may be used, or any of 
the commonly employed forms of oatmeal. 

When any of these farinaceous foods are to be 
mixed with milk, the milk should be added directly 
after removing the gruel from the fire, and stirred 
two or three minutes. 

Albumin Wafer,— The white of one fresh egg] 
half a pint of cold water ; pinch of salt ; teaspoonf ul 
of brandy. This should be shaken thoroughly and 
fed cold either with a spoon or from a bottle. It is 
useful in cases of vomiting, and can sometimes be 
retained by a very irritable stomach. 

Lime-Water. — One heaping teaspoonful of slaked 
lime; one quart boiled or distilled water; place in 
a corked bottle and shake thoroughly two or three 
times during the first hour. The lime should then 
be allowed to settle, and after twenty-four hours 



FOOD FORMULAS 157 

the upper clear fluid carefully poured or siphoned 
off for use. 

Dried Bread, — Either stale or fresh bread may 
be used; it is cut in thin slices and placed in the 
oven, with the door open, and quickly dried until 
it is crisp, but not browned. It is in many respects 
preferable to crackers for little children. 

Coddled Egg. — A fresh egg, shell on, is placed 
in boiling water which is immediately after re- 
moved from the fire. The egg then cooks slowly in 
the water, which gradually cools, for seven or eight 
minutes, when the white should be about the con- 
sistency of jelly. For a delicate digestion the white 
only should be given, with salt; it can be easily 
separated from the yolk. 



PART IV 
MISCELLANEOUS 



MISCELLANEOUS 

THE BOWELS 

How many movements daily should an infant 
have during the first few weehs of life? 

Usually two or three a day for the first week, 
and then one or two each day. 

How many after a child is a month old? 

A healthy child should have at least one move- 
ment each day; many have two and some more than 
two; but it is the character of the stools rather than 
their number which is to be taken as the evidence 
of perfect digestion. 

What is the appearance of a healthy movement 
of a child who is taking nothing hut milk? 

It is soft, yellow, and smooth, containing no 
lumps. 

When are the stools dark hrown or black? 

While taking bismuth, iron, and sometimes when 
taking much meat or beef juice; also while taking 
many of the prepared foods- They may be dark 

161 



162 THE CAEE AND FEEDING OF CHILDKEN 

brown or^black from blood. This last is a condition 
which may indicate serious illness. 

How may a child he trained to he regular in the 
action of its howels? 

By endeavoring to have them move at exactly 
the same time every day. 

At what age may an infant he trained in this 
way? 

Usually by the second month if training is be- 
gun early. 

What is the hest method of training? 

A small chamber, about the size of a pint bowl, 
is placed between the nurse's knees, and upon this 
the infant is held, its back being against the nurse's 
chest and its body firmly supported. This should be 
done twice a day, after the morning and afternoon 
feedings, and always at the same hour. At first 
there may be necessary some local irritation, like 
that produced by tickling the anus or introducing 
just inside the rectum a small cone of oiled paper 
or a piece of soap, as a suggestion of the purpose 
for which the baby is placed upon the chamber; 
but in a surprisingly short time the position is all 
that is required. With most infants after a few 
weeks the bowels will move as soon as the infant is 
placed on the chamber. 



SLEEP 163 

What advantage has such training? 

It forms the habit of having the bowels move 
regularly at the same hour, which is a matter of 
great importance in infancy and makes regularity 
in childhood much easier. It also saves the nurse 
much trouble and labour. 

SLEEP 

Should a child sleep in the same bed with its 
mother or nurse? 

Under no circumstances, if this can possibly be 
avoided. Very young infants have often been 
smothered by their mothers by overlying during 
sleep. If the infant sleeps with the mother, there 
is always the temptation to frequent nursing at 
night, which is injurious to both mother and child. 
Older children also should, if possible, have separate 
beds; many contagious diseases and bad habits are 
contracted by children sleeping together. 

Hoiu should an infant's bed be prepared? 

The mattress should be firm but soft, the pillow 
very thin, and the covering not excessive. A baby 
should not be allowed to sleep always in the same 
position, but should be changed from side to side. 
Hair pillows are useful in summer and for children 
who perspire very much. 



164 THE CAEE AND FEEDING OF CHILDEEN 

How much sleep is natural for a newly-horn 
hahy? 

A baby with a good digestion and proper food 
will usually sleep at this period about nine tenths 
of the time. 

How much should a bahy sleep at six months? 
About two thirds of the time. 

Up to what age should an older child take a nap 
during the day? 

Always until four years old, and if possible 
until seven or eight years old. 

At what age may an infant go all night with- 
out feeding? 

After five months a healthy child should not be 
fed or nursed between 10 p. m. and 6 a. m. Some 
children at this age habitually go from 6 p. m. to 6 
A. M. without f eedingj and thrive well on this regime. 

At two years a child can easily go from 6 p. m. 
to 6 A. M. without feeding. 

How should a hahy he put to sleep? 

The room should be darkened and quiet, the 
child's hunger satisfied, and the child made gen- 
erally comfortable and laid in its crib while awake. 

Is rocking necessary? 

By no means. It is a habit easily acquired, but 



SLEEP 165 

hard to break, and a very useless and sometimes 
injurious one. The same may be said of sucking 
a rubber nipple, or '^ pacifier/' and all other 
devices for putting children to sleep. 

What are the principal causes of disturbed 
sleep ? 

As quiet peaceful sleep is a sign of perfect 
health, disorders of sleep may be produced by almost 
anything which is wrong with the child. 

1. Habitual disturbance of sleep in infants is 
most frequently associated with the food or feeding. 
It may be from the discomfort of chronic indigestion 
due to improper food. In bottle-fed infants it is 
often the result of overfeeding; in those who are 
nursed it is often due to hunger. A common cause 
is frequent night feeding ; an infant who is fed three 
or four times during the night is almost invariably 
a bad sleeper. 

2. Disturbed sleep or sleeplessness may be due 
to causes purely nervous. Such are bad habits ac- 
quired by faulty training; as when the nursery is 
lighted and the child taken from its crib whenever 
it wakes or cries ; or when some of the contrivances 
for inducing sleep have been used. Any excitement 
or romping play just before bedtime, and fears 
aroused by pictures or stories, are frequent causes. 



166 THE CAKE AND FEEDING OF CHILDEEN 

Children who inherit from their parents a nervous 
constitution are especially likely to suffer thus. 

3. There may be physical discomfort from cold 
feet, insufficient or too much clothing, or want of 
fresh air in the sleeping room. 

4. Interference with breathing due to obstruc- 
tion from large tonsils or adenoids. These cause 
great restlessness and lead a child to assume many 
different postures during sleep, often lying upon the 
face or upon the hands and knees. 

5. Chronic pains or frequently recurring night 
pains may be causes of disordered sleep, when a 
child wakes with a sudden sharp cry. In infants 
this is most often due to scurvy, sometimes to 
syphilis. In older children it may be the earliest 
symptom of disease of the hip or spine. 

6. Sleeplessness and disturbed sleep are frequent 
whenever the general condition falls much below a 
healthy standard; e. g., in infants who are not 
thriving and in children suffering from marked 
anaemia. 

How are children who sleep too little, or whose 
sleep is constantly disturhed, to he treated? 

Never by the use of soothing sirups or other 
medicines. Successful treatment consists in the 
discovery and removal of the cause. 



EXEECISE 167 

Do children ever sleep too much? 

It is doubtful if healthy children ever do. Ex- 
cessive sleep is an important symptom of some dis- 
eases of the brain. Otherwise it seldom if ever 
occurs unless soothing sirups or other drugs have 
been given. 

EXERCISE 

Is exercise important for infants? 

It is as necessary for them as for older children. 

How is it obtained? 

A young baby gets its exercise by screaming, 
waving its arms, kicking, etc. The clothing should 
not be so tight as to make these movements impos- 
sible. At least twice a day the infant should be 
allowed for fifteen or twenty minutes the free use of 
its limbs by permitting it to lie upon a bed in a 
warm room, with all clothing except the shirt, stock- 
ings, and napkin removed. Later, when in short 
clothes, the baby may be put upon a thick blanket 
or quilt laid upon the floor, and be allowed to tumble 
about at will. A nursery pen two feet high, made 
to surround a mattress, is an excellent device and 
makes a convenient box stall for the young animal, 
where it can learn to use both its arms and legs with- 



168 THE CAEE AND FEEDING OF CHILDREN 

out the danger of injury. Only by exercise such as 
this do the muscles have an opportunity to develop 
properly. 

THE CKY 

When is crying useful? 

In the newly born infant the cry expands the 
lungs, and it is necessary that it should be repeated 
for a few minutes every day in order to keep them 
well expanded. 

How much crying is normal for a very young 
bahy? 

From fifteen to thirty minutes a day is not too 
much. 

What is the nature of this cry? 

It is loud and strong. Infants get red in the 
face with it; in fact, it is a scream. This is neces- 
sary for health. It is the baby's exercise. 

When is a cry abnormal? 

When it is too long or too frequent. The ab- 
normal cry is rarely strong, often it is a moaning 
or a worrying cry, sometimes only a feeble whine. 

What are the main causes of such crying? 
Pain, temper, hunger, illness, and habit. 



THE CRY 169 



What is the cry of pain? 

It is usually strong and sharp, but not generally 
continuous. It is accompanied by contraction of the 
features, drawing up of the legs, and other symptoms 
of distress. 

What is the cry of hunger? 
It is usually a continuous, fretful cry, rarely 
strong and lusty. 

What is the cry of temper? 

It is loud and strong and accompanied by kick- 
ing or stiffening of the body, and is usually violent. 

What is the cry of illness? 

There is usually more of fretfulness and moan- 
ing than real crying, although crying is excited by 
very slight causes. 

What is the cry of indulgence or from hahit? 

This is often heard even in very young infants, 
who cry to be rocked, to be carried about, sometimes 
for a light in the room, for a bottle to suck, or for 
the continuance of any other bad habit which has 
been acquired. 

How can we be sure that a child is crying to he 
indulged? 

If it stops immediately when it gets what it 
wants, and cries when it is withdrawn or withheld. 



170 THE CAEE AND FEEDING OF CHILDEEN 

What should he done if a hahy cries at night? 

One should get up and see that the child is com- 
fortable — the clothing smooth nnder the body, the 
hands and feet warm, and the napkin not wet or 
soiled. If all these matters are properly adjusted 
and the child simply crying to be taken up, it 
should not be further interfered with. If the 
night cry is habitual some other cause should be 
sought. 

How is an infant to he managed that cries from 
temper, hahit, or to he indulged? 

It should simply be allowed to '' cry it out.'^ 
This often requires an hour, and, in extreme cases, 
two or three hours. A second struggle will seldom 
last more than ten or fifteen minutes, and a third 
will rarely be necessary. Such discipline is not to 
be carried out unless one is sure as to the cause of 
the habitual crying. 

Is it likely that rupture will he caused from 
crying ? 

Not in young infants if the abdominal band is 
properly applied, and not after a year under any 
circumstances. 

LIFTIITG CHILDREN 

How should a young hahy he lifted from its hed? 
The right hand should grasp the clothing below 



THE TEMPEEATUEE 171 

the feet, and the left hand should be slipped beneath 
the infant's body to its head. It is then raised upon 
the left arm. 

What is the advantage of this? 

The entire spine is supported, and no undue 
pressure is made upon the chest or abdomen, as 
often happens if the baby is grasped around the 
body or under the arms. 

How should a child old enough to run about he 
lifted? 

Always by placing the hands under the child's 
arms, and never by the wrists. 

What injury may he inflicted hy lifting the child 
hy the wrists or hands? 

Often serious injury is done to the elbow or 
shoulder joints. 

THE TEMPERATURE 

What is the normal temperature of an infant? 

The normal temperature varies more than in 
adults. In the rectum it usually fluctuates between 
98° and 99.5° P.; a rectal temperature of 97.5° F. 
or of 100.5° F. is of no importance whatever un- 
less it continues. 



172 THE CAEE AND FEEDING OF CHILDEEN 

Where should the temperature of infants and 
young children he taken? 

The rectum is altogether the best place, and next 
to this the groin. The rectal temperature is from 
half a degree to a degree higher than that in the 
groin. 

How long should the thermometer he left in 
place to take the temperature? 

Two minutes in the rectum, and five minutes in 
the groin. 

Is the temperature of a young child a good guide 
as to the severity of its symptoms in illness? 

As a rule it is. A temperature of 100^ to 102° 
F. commonly means a mild illness, and one of 104° 
F. or over a serious one. The duration of the fever 
is, however, even more important than the height of 
the temperature. It should be remembered that in 
all young children slight causes often produce a high 
temperature which lasts for a few hours ; one should 
not therefore be unduly alarmed unless the tempera- 
ture continues high, or is accompanied by other im- 
portant signs of illness. 

Is not a high temperature a more serious symp- 
tom in a young child than in an adult? 

The opposite is rather the case. Young children 
are extremely sensitive to conditions which produce 



NERVOUSNESS 173 



fever, and the thermometer often gives an exagger- 
ated idea of the severity of the symptoms. A cause 
which in an adult might produce a temperature of 
102° F. or 103° F. in a young child would very 
likely be accompanied by a temperature of 104° or 
105° F. 

KERVOTJSITESS 

WTiat are the principal causes of excessive nerv- 
ousness in infants and young children, and what can 
be done to prevent this? 

The most important cause is the delicate struc- 
ture of the brain at this time, and its rapid growth. 
It grows as much during the first year as during all 
the rest of life. This requires quiet and peaceful 
surroundings. Infants who are naturally nervous 
should be left much alone, should see but few people, 
should be played with very little, and should never 
be quieted with soothing sirups or the '^ pacifier." 

At what age may playing with hahies he hegun? 

Babies under six months old should never be 
played with; and the less of it at any time the bet- 
ter for the infant. 

What harm is done hy playing with very young 
hahies? 

They are made nervous and irritable, sleep 



174 THE CAEE AND FEEDING OF CHILDEEN 

badly, and suffer from indigestion and in many 
other respects. 

When may young children he played with? 
If at all, in the morning, or after the mid-day 
nap; but never just before bedtii$ie. 

TOYS 

What points should guide one in selecting toys 
and playthings for an infant? 

The instinct in a baby to put everything into 
the mouth is so strong that nothing should be given 
that cannot be safely treated in this way. Hence 
one should choose things which are smooth, those 
which can be easily washed, and those which can- 
not be swallowed. 

One should avoid (1) toys with sharp points or 
corners; (2) those with loose parts that might be 
detached or broken off and swallowed; (3) small 
objects which might be swallowed or pushed into 
the nose or ear, such as coins, marbles, and safety- 
pins, also beads and buttons unless strung upon a 
stout cord; (4) painted toys; (5) those covered with 
hair or wool. Infants have often been severely in- 
jured by swallowing what they have pulled off 
from their small toy animals. 



TOYS 175 

What points are to he considered in selecting the 
toys and playthings of a child over two years old? 

It should be remembered that toys are not 
merely a source of amusement, but that they have 
an educational value as well. Those are therefore 
to be preferred the use of which develops the child's 
imagination, and with which he can be taught to 
amuse himself. For boys nothing can surpass 
blocks, toy soldiers, balls, engines and trains of 
cars; and for girls, dolls and housekeeping sets. 
The complicated mechanical toys now so much in 
vogue usually give only a momentary pleasure, and 
as soon as the wonder at their operation has worn 
off, they have lost interest for the child except that 
which he gets in breaking them to see how the thing 
worked. 

What important things can l)e taught children 
with their toys and how may this he done ? 

The imagination may be developed, and children 
may be trained to habits of neatness, order and regu- 
larity, and to concentration of mind. 

To this end toys should be kept in an orderly 
way upon a shelf in the nursery or in a closet, 
never piled in a miscellaneous heap in the corner of 
the room. Children should select their toys and 
play with one thing at a time, which they should 



17o THE CARE AND FEEDING OF CHILDREN 

be taught to put away in its place before another 
is given. They should never be allowed to have a 
dozen things strewn about the room at one time, 
with none of which they are occupied. 

KISSING 

Are there any valid objections to hissing inr 
fants? 

There are many serious objections. Tuberculo- 
sisj diphtheria, syphilis, and many other grave dis- 
eases may be communicated in this way. The kiss- 
ing of infants upon the mouth by other children, 
by nurses, or by people generally, should under no 
circumstances be permitted. Infants should be 
kissed, if at all, upon the cheek or forehead, but the 
less even of this the better. 

coi^vuLsioisrs 

What should he done for a child in convulsions 
before a doctor arrives? 

Keep the child perfectly quiet with ice at the 
head, put the feet in a mustard bath, and roll the 
entire body in large towels which have been dipped 
in mustard water (two heaping tablespoonfuls of 
mustard to one quart of tepid water), and have 



rOKEIGN BODIES 177 



plenty of hot water and a bath tub at hand, so that 
the doctor can give a hot bath if he thinks it advis- 
able. 

When is a hot hath useful? 

If the convulsions have continued until the pulse 
is weak, the face very pale, the nails and lips blue, 
and the feet and hands cold, the hot bath will be 
useful by bringing blood to the surface and relieving 
the heart, lungs, and brain. 

How should the bath he given? 

The temperature should not be over 106° F. ; 
this should always be tested by a thermometer if one 
can be obtained. Without this precaution, in the ex- 
citement of the moment, infants have frequently 
been put into baths so hot that serious and even fatal 
burns have been produced. If no thermometer is 
available the nurse may plunge her arm to the elbow 
into the water. It should feel warm, but not so hot 
as to be at all uncomfortable. One half a teacupful 
of powdered mustard added to the bath often adds 
to its efScacy. 

FOREIGN" BODIES 

What should he done if a foreign hody has heen 
swallowed? 

First, examine the throat with the finger. If it 
has lodged there remove it. If it has passed from 



178 THE CARE AND FEEDING OF CHILDREN 

the throat it has usually gone into the stomach. 
Next be sure that the object has actually been swal- 
lowed. Often needless alarm is allayed by finding 
in the child's crib or elsewhere the thing supposed 
to have been swallowed. The stools should be ex- 
amined daily to see if the foreign body passes the 
bowel. 

What further treatment is needed? 

Give the child plenty of dry food, like bread, 
potato, etc., but under no circumstances either an 
emetic or cathartic. An infant may have its usual 
food. 

What harm would a cathartic do? 

It is likely to hurry the foreign body too rapidly 
through the intestine and in this way do harm; 
otherwise it becomes coated with faecal matter and 
passes the intestine usually without doing injury. 

'Not only smooth objects such as buttons or coins 
are taken care of in this manner, but even sharp 
and pointed objects such as safety pins are usually 
passed through the bowel without causing pain or 
inflicting any injury. 

How long a time is required for a foreign hody 
to pass the howel? 

In most cases but three or four days, occasionally 
a week or ten days. 



COLIC 179 



What should he done if a child gets a foreign 
body into the ear? 

Unless this can easily be removed witli the 
fingers it should not be meddled with, for it is likely 
to be pushed farther into the ear. The child should 
be taken to a physician. 

What should he done if there is a foreign hody 
in the nose? 

The child should blow his nose strongly while 
the empty nostril is compressed. Unless this re- 
moves it a physician should be called. Meddlesome 
interference is always harmful. 

COLIC 

What are the symptoms of colic? 

There is a strong, hard cry, which comes sud- 
denly and returns every few minutes. With this 
there is drawing up of the feet, contraction of the 
muscles of the face, and other signs of pain. The 
abdomen is usually tense and hard. 

What should he done for a hahy with colic? 

First, see that the feet are warm. Place them 
against a hot-water bag, or hold them before an open 
fire; apply a hot flannel to the abdomen, or let the 
child lie upon its stomach across a hot-water bag. 
If the colic continues, a half teacupful of warm 



180 THE CAEE AND FEEDING OF CHILDEEN 

water containing ten drops of turpentine may be 
injected into the bowels with a syringe; at the same 
time the abdomen should be gently rubbed so as to 
start the wind. If the gas is in the stomach, half 
of a soda mint tablet may be given in a tablespoon- 
ful of very warm water. 

EARACHE 

WJiat are the symptoms of earache? 

The pain is generally severe and accompanied by 
a sharp scream; the child often puts the hand to 
the affected ear, or cries whenever it is touched. 
The pain is likely to be prolonged and continuous. 

How should a child with earache he treated? 

The ear should be irrigated with a solution of 
boric acid (twenty grains to the ounce) as warm as 
can be borne. Dry heat may then be applied in 
several ways. The ear having been first covered 
with cotton, a small hot-water bag or one filled with 
hot salt or bran may be bound over it with a 
bandage ; or a small butter plate heated in hot water 
may be used in the same way. The hot-water bag 
may be held against the ear or the child may lie 
with his head upon it. The use of such substances 
as oil and laudanum in the ear is not to be recom- 
mended. 



CEOUP 181 



CROUP 

What are the symptoms of croup? 
There is a hollow, dry, barking cough, with 
some difficulty in breathing. 

When is this likely to come on? 
Usually at night. 

Is simple croup dangerous? 

The ordinary croup of infants is spasmodic 
croup, and is very rarely dangerous, although the 
symptoms seem very alarming. 

What are the symptoms? 

In a mild attack there is simply noisy breath- 
ing, especially on drawing in the breath, with a 
tight, barking, or croupy cough. In a severe attack 
the child's breathing is more noisy and becomes 
difficult. 

What is the dangerous form of croup? 
Membranous croup, which is the same thing as 
diphtheria of the larynx. 

How does this develop? 

Gradually; very rarely does it come on sud- 
denly. 

What should he done for a hahy who has spas- 
modic croup? 

The room should be very warm, hot clothes or 



182 THE CAEE AND FEEDING OF CHILDEEN 

poultices should be applied over the throat, and 
either a croup kettle or an ordinary tea-kettle kept 
boiling in the room. This is more efficacious if the 
child is placed in a tent made by a raised umbrella 
with a sheet thrown over it, and the steam intro- 
duced beneath the tent. If the symptoms are 
urgent, ten drops of the sirup of ipecac should be 
given every fifteen minutes until freo vomiting 
occurs. Whenever the symptoms reach a point 
where breathing becomes difficult, a doctor should 
be summoned without delay. 

CONTAGIOUS DISEASES 

What are the first symptoms of measles? 

Measles comes on rather gradually with cough, 
sneezing, watery eyes and nose, much like an ordi- 
nary severe cold in the head. The eruption appears 
after three or four days, first upon the face and 
neck as small red spots, and spreads slowly over the 
body. 

75 measles a serious disease? 

In infants and during the winter season it is 
likely to be very serious on account of the danger 
of bronchitis and pneumonia, which frequently ac- 
company it. In children over four years old it is 
generally not severe. No child should be voluntarily 



CONTAGIOUS DISEASES 183 

exposed to this disease, and particularly one who is 
delicate or prone to disease of the lungs should be 
protected against it. 

When and how is measles contagious? 

Measles may readily be conveyed from the very 
beginning of the catarrh, two or three days before 
any eruption is present. It is very seldom carried 
by healthy persons. Its noison does not cling long 
to a sick room. 

What is German measles? 

German measles, or rubella, is a distinct disease 
and has nothing to do with ordinary measles. It is 
extremely rare for a child to be very ill with it. 
There is usually a very extensive eruption which 
may cover the body, but few other symptoms. 

What are the first symptoms of scarlet fever? 

Generally it comes abruptly, with vomiting, high 
fever, and sore throat. The eruption usually ap- 
pears within twenty-four hours as a red blush, first 
upon the neck and chest, and spreads rapidly. 

When and how is scarlet fever contagious? 

Scarlet fever is only slightly contagious for the 
first one or two days of the attack. It is most con- 
tagious at the height of the disease and during 
desquamation. Mild cases are quite as contagious 



184 THE CAEE AND FEEDING OF CHILDEEN 

as severe ones. In fact it is by the mild unrecog- 
nized cases that the disease is very often spread. 
It may be carried by clothing or bedding from the 
sick room and, though infrequently^ by healthy per- 
sons who have been in contact with cases. 

How does whooping-cough, begin? 

For a week or ten days it cannot be distinguished 
from the cough due to an ordinary cold on the chest. 
Then the attacks of coughing gradually become more 
severe, especially at night, the child gets red in the 
face, the eyes water with the paroxysm and vomit- 
ing may follow. After a severe coughing fit the 
breath is caught with a peculiar noise known as the 
^Vhoop.'^ 

How does chicken-pox hegin? 

It usually comes out gradually, as widely scat- 
tered pimples over the scalp, face, and body, many 
of which soon become small vesicles, resembling tiny 
blisters and afterwards dry to form crusts. There 
is itching and local discomfort but little fever, and 
the child rarely seems to be very ill. 

How does diphtheria hegin? 

Sometimes suddenly, but usually gradually, with 
sore throat and swelling of the glands of the neck, 
with white patches upon the tonsils, or a free dis- 
charge, which may be bloody, from the nostrils. 



CONTAGIOUS DISEASES 185 

How does mumps begin? 

As a swelling upon the jaw, just beneath the 
ear. As it increases it extends forward upon the 
cheek and backward behind the ear. It may afPect 
one or both sides. 

Mumps is not very common in young children, 
and in them it is usually mild. After twelve or 
thirteen years it is likely to be more severe. 

How long after exposure do the first symptoms 
appear in the different diseases? 

In scarlet fever in from two to five days, rarely 
as late as a week ; in measles in from nine to four- 
teen days, occasionally as late as twenty days; in 
whooping-cough in from one to two weeks; in 
chicken-pox in from fourteen to sixteen days; in 
German measles in from ten to sixteen days. In 
diphtheria the time varies much; it may be only 
one day, and it may be one or two weeks. In 
mumps it is usually a little less than three weeks, 
the average being twenty days. 

Which of these diseases are most contagious? 

Measles and chicken-pox are very contagious, 
and very few children who have not had them can 
come near a person suffering from either disease 
without taking it. Whooping-cough is almost as con- 
tagious as measles, and for young babies even more 



186 THE CARE AND FEEDING OF CHILDREN 

SO. A very close exposure is not necessary in the 
case of either of these diseases^ and whooping- 
congh can undoubtedly be contracted in the open 
air. Scarlet fever and diphtheria are much less con- 
tagious ; for both of these a pretty close exposure is 
necessary. 

How long should a child with any of these dis- 
eases 'he kept away from other children? 

With measles, for two weeks after the rash has 
gone ; with scarlet fever, for at least four weeks after 
the rash has gone, and longer if the peeling is not 
over or if the ears are running; with whooping- 
cough, for two months, or so long as the paroxysmal 
cough continues; with chicken-pox, until all crusts 
have fallen off, or for about three weeks after the 
eruption appears; with German measles for one 
week after the eruption has faded; with diphtheria, 
at least ten days after the throat is well in a very 
mild case, and four weeks if the case has been 
severe or until cultures show the throat to be free 
from the diphtheria germs; with mumps for one 
week after the swelling has gone. 

What should he done when a child shows the 
first symptoms of serious illness? 

The child should be put to bed. If it is an 
infant, the food should be diluted to one half the 



SCUKVY 187 



usual strength; if an older child, only fluid food 
should be given. If the child seems feverish, take 
the temperature. If the bowels are constipated, give 
a teaspoonful of castor oil, but no other medicine 
without the doctor's orders. Send for the doctor at 
once, and until he comes carefully exclude all other 
children from the room. 

By rvhat nursery training may the examination 
and treatment of sick children he made much easier? 

By teaching all children to gargle, to show the 
throat, to take pills, and by constantly teaching them 
to regard the doctor as the child's best friend, and 
his visits as a great treat. On no account should a 
child be frightened into obedience by threats of what 
the doctor will do. 

With care and patience most children may be 
taught to gargle and take pills at four or five years, 
and to show the throat willingly at two or three. 
All these matters should be made a part of the 
child's education. 

SCURVY 

What is scurvy and how is it produced? 

Scurvy is a disease of general nutrition, usually 
caused by the long-continued use of improper food. 
Most of the cases come from the use of the prepared 



188 THE CAEE AND FEEDING OF CHILDKEN 

infant's foods sold in the stores, especially when 
they are given without fresh milk; occasionally the 
use of condensed milk and of sterilized milk is fol- 
lowed by scurvy; sometimes it is seen when, owing 
to feeble digestion, it has been necessary to make 
cow's milk very weak for a long time. 

What symptoms are seen in an infant with 
scurvy ? 

At first there is only indefinite and occasional 
soreness in the legs so that the child cries out when 
handled. As this soreness becomes more severe the 
child is often thought to have rheumatism. The 
gums swell and are of a deep purple colour. There 
may be bleeding from the gums, nose, bowels, or 
black-and-blue spots may be seen upon the legs. The 
ankles and knees may swell. The child grows very 
pale, loses appetite and weight, and sleeps badly. 

What should he done when an infant shows signs 
of scurvy? 

The diet should at once be changed to fresh milk, 
properly modified according to the child's digestion, 
but not sterilized or pasteurized. The juice of a 
sweet orange should be given, best about an hour 
before the feeding. At first three or four teaspoon- 
fuls, four or five times a day; later, more may be 
given if the symptoms are not improved. 



CONSTIPATION 18^ 



Properly treated an infant with scurvy generally 
recovers promptly and completely. If not recog- 
nized, or untreated, it may cause death. 

CONSTIPATIOIS' 

When it is necessary to move the bowels imme- 
diately, what are some of the easiest methods? 

An injection of one tablespoonful of sweet oil 
may be given, or half a teaspoonful of glycerine in 
one tablespoonful of water, or a teacupful of tepid 
soap and water, or a glycerine suppository. None 
of these should be continued excepting under the 
physician's directions. 

What sort of a syringe is to be preferred for giv- 
ing an injection to an infant? 

The bulb syringe is the simplest ; this consists of 
an oval bulb of soft rubber and a soft rubber or a 
hard rubber tip. It holds one or two ounces. 

What is the most essential thing in preventing 
or overcoming constipation? 

The formation of the habit of having the bowels 
move every day regularly at the same hour, and 
proper early training (see page 162). 

What is the best hour? 

In most cases immediately after the first meal 
in the morning. 



190 THE CAKE AND FEEDING OF CHILDEEN 

What are some simple means hy which constipa- 
tion may he relieved? 

The best are diet, suppositories, and massage. 

The changes to be made in the milk of consti- 
pated infants have been mentioned on page 96. The 
addition to the milk of some of the preparations of 
maltose mentioned on page 65 is often useful. For 
little children the fruit juices are particularly 
beneficial when given half an hour or more before 
the first morning feeding, with half a glass of water. 

For older children the amount of white bread, 
toast, and potato, should be reduced, and green vege- 
tables, oatmeal, and Graham bread given, with 
plenty of fruit twice a day. Eaw scraped apples are 
sometimes of more value than any other fruit. 

The best suppositories for continuous use are 
probably the gluten suppositories of the Health 
Food Company. One should be given the first 
thing in the morning. They act rather slowly, usu- 
ally in about two hours. In obstinate cases one may 
also be used at bedtime. Glycerine suppositories 
act more quickly, but are too irritating for regu- 
lar use. 

Massage consists in rubbing the abdomen, which 
may be done in one of two ways: Beginning at the 
right groin, the hand is carried up to the ribs, then 
across to the opposite .'^'^'de, then around to the left 



BAD HABITS 193 



When is this habit most frequently seen? 

It begins in quite early infancy, and if not 
broken may last until children are six or seven 
years old. 

Is the sucTcing habit a harmful one? 

When persisted in it may produce a misshapen 
mouth or fingers. It constantly stimulates the flow 
of saliva and certainly aggravates disturbances of 
digestion during v^hich the sucking habit is likely 
to be practised. It may lead to thrush or other 
forms of infection of the mouth. It is not necessary 
as a means of quieting a child, though it may in 
some degree cover up the consequences of bad feed- 
ing or bad training. On no account should the 
habit of sucking the "pacifier'' be allowed as a 
means of putting children to sleep, or of quieting 
them while restless from dentition or indigestion. 

How is the sucJcing habit to be controlled? 

One should be sure in the first place that the 
constant sucking of fingers is not due to hunger from 
insuflScient food. Sucking of the hands may often 
be controlled by wearing mittens or fastening the 
hands to the sides during sleep. In more obstinate 
cases it may be necessary to confine the elbow by 
small pasteboard splints to prevent the child from 
bending the arm so as to get the hand to the mouth. 



194 THE CARE AND FEEDING OF CHILDREN 

When are nail-hiting and dirt-eating seen, and 
how are they to he controlled? 

These habits belong especially to children over 
three years old. They are seen particularly in those 
who are excessively nervous or whose general health 
is below par ; sometimes in those who develop serious 
nervous diseases later in life. Children with such 
tendencies should be closely watched, and every 
means used to break up these habits early. Dirt- 
eating is a morbid craving which is rarely seen in 
a normal child. 

At what age may a child generally he expected 
to go without wetting the hed during the night? 

Usually at two and a half years, if it is taken 
up late in the evening. Some children acquire con- 
trol of the bladder at night when two years old, 
and a few not until three years. After three years 
habitual bed-wetting is abnormal. 

How should a young child addicted to hed- 
wetting he managed? 

At three or four years of age, punishments are 
sometimes useful, especially when it seems to de- 
pend more upon the child's indifference than any- 
thing else. They are of no value in older children, 
rewards being much more efficacious. In all cases 
one should give a child plenty of milk and water 



BAD HABITS 195 



early in the day, but no fluids after 4 p. m.^ the sup- 
per being always of solid or semi-solid food. The 
child should be taken up regularly at ten o'clock or 
thereabouts. It often happens that the formation 
or continuance of the habit is due to the child being 
ansemic or otherwise in poor general condition, to 
some irritation in the urine, or in the genital organs. 
Unless the simple means mentioned are successful 
the child should be placed under the charge of a 
physician. 

What is masturbation? 

It is the habit of rubbing the genital organs with 
the hands, with the clothing, against the bed, or rub- 
bing the thighs together. Sometimes a child sits 
upon the floor, crosses its thighs tightly and rocks 
backward and forward. Many of these things are 
passed over lightly and are regarded for months as 
simply a "queer trick" of the child. It may be 
seen at any age, even in those not more than a year 
old, and in both sexes. 

How should such a child he treated? 

Masturbation is the most injurious of all the bad 
habits, and should be broken up just as early as pos- 
sible. Children should especially be watched at the 
time .of going to sleep and on flrst waking. Punish- 
ments and mechanical restraint are of little avail 



196 THE CARE AND FEEDING OF CHILDREN 

except with infants. With older children they 
usually make matters worse. Rewards are much 
more efficacious. It is of the utmost import- 
ance to watch the child closely, to keep his confi- 
dence, and by all possible means to teach self-con- 
trol. 

Some local cause of irritation is often present, 
which can be removed. Medical advice should at 
once be sought. 

VACCIITATION- 

Nowadays when small-pox occurs so seldom is it 
necessary to have every child vaccinated? 

It should by all means be done. It is only by 
the practice of general vaccination that small-pox is 
kept down. In countries or in communities where 
vaccination is neglected, frightful outbreaks of 
small-pox occur every now and then just as in olden 
times. 

What is the best time for vaccination? 

The time usually selected is from the third to 
the sixth month. It may be deferred in a very 
delicate child who is not likely to be exposed to 
small-pox, or in a child suffeT;*ing from any form 
of skin disease. 



ADENOIDS 197 



Which is preferable for vaccination, the arm or 
the leg? 

The part which can be most easily protected and 
kept at rest is to be chosen. In infants who do not 
yet walk or creep, the leg is to be preferred ; in older 
children, in most circumstances, the arm. If older 
children are vaccinated on the leg, they should not be 
allowed to walk much while the vaccination is active. 

When should vaccination he repeated? 

An unsuccessful vaccination proves nothing and 
should be repeated in two or three weeks. If suc- 
cessfully vaccinated in infancy, a child should in- 
variably be revaccinated before puberty. If exposed 
or likely to be exposed to small-pox at any time vac- 
cination should be repeated. 

ADEI^OIDS 

What are adenoids? 

The name is given to a lymphatic, glandular mass 
which is situated back of the nose in the upper part of 
the throat. 

Do all children have adenoids? 

They are one of the normal structures of the body. 

Under what circumstances do they require re- 
moval? 

When they become much enlarged or are the seat 
of disease. 



198 THE CARE AND FEEDING OE CHILDKEN 

What are the signs of much enlargement? 

Mouth breathings restlessness at night, or snoring 
respiration during sleep, and in marked cases nar- 
rowing or sinking in of the lower part of the chest, 
owing to obstructed breathing and interference with 
the general health and normal growth. Also, there 
may result a narrowing of the dental arch of the up- 
per jaw leading to deformity of the mouth. 

What are the signs of diseased adenoids? 

The most common are, frequently recurring acute 
head colds or a chronic nasal discharge, and swelling 
of the glands of the neck. There may also be attacks 
of earache or more serious inflammation of the ears, 
resulting in abscesses which may discharge for a 
long time. 

Should all children have adenoids removed? 

When either group of symptoms mentioned 
above are present this should be done, and if both 
groups are present removal is imperative. When none 
of these symptoms exist operation is unnecessary. 

At what age should the operation he done? 

The time of operation is determined not so much 
by the age of the child as the urgency of the symp- 
toms. It may be necessary at any age even in an 
infant under one year. Generally speaking, opera- 
tion should be deferred until the child has passed the 
age of two or three years, as the chances of recur- 



ENLAEGED TONSILS 199 

rence are somewhat less than when the operation is 
done in infancy. 

Are adenoids likely to recur after removal? 

If the operation is properly performed this oc- 
curs only in a small proportion of the cases, perhaps 
10 or 15 per cent. 

EIN^LAEGED TON^SILS 

Under what circumstances should the tonsils he 
removed? 

The symptoms requiring removal are much the 
same as those described with adenoids. The ton- 
sils should be removed if they are so large that they 
obstruct respiration, or by inspection are seen nearly 
to meet in the throat. Also, when they are the seat of 
chronic disease. Often they are ragged, irregular, soft 
and spongy, although they may not be greatly enlarged. 

Is it sufficient to amputate the tonsils, or should 
they he completely removed? 

At present surgeons are generally agreed that in 
cases requiring operation, the complete removal of 
the tonsils is to be preferred. 

Are there any dangers from operation upon ton- 
nls or adenoids? 

If the operation is properly performed, the risk 
is very slight indeed, but in rare cases serious hem- 
orrhage may occur. 



CHART I 



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202 



INDEX 



INDEX 



Adenoids, 166, 197-199. 
Air, fresh, effects of, 30. 
Airing the child, indoors, 28. 

out of doors, 29, 30. 
Airing the nursery, 26. 
Albumin water, 156. 
Alcohol lamp, 106. 
Anaemic infants, beef juice 

for, 87. 
Appetite, 82. 

lack of, food changes in- 
dicated by, 100, 101. 

loss of, 38, 92. 

overfeeding and, 90. 
Artificial feeding, 57. 

Band, abdominal, 22. 
Barley gruel, 155. 
Barley jelly, 155. 
Barley water, 154. 

use of, 51, 100, 101. 
Baths, 15, 16. 

bran, 20. 

cold sponge, 31. 

hot, for convulsions, 177. 



Baths, salt, 20. 

Bed-wetting, 192, 194, 195. 

Beds, 163. 

Beef, scraped, 154. 

Beef broth, 153. 

Beef juice, 152. 

addition of, to milk, 87. 
by the cold process, 152. 

Beverages for children, 144, 
145. 

''Biliousness," 135. 

Borden's Eagle brand con- 
densed milk, 88. 

Bottle, for children weaned 
from the breast, 53. 
preparation of, at feeding 

time, 107. 
weaning from, 54, 55, 124. 

Bottle-fed infants, mortality 
of, 44. 

Bottle-feeding and gain in 
weight, 32. 
combined with breast-feed- 
ing, 50. 

''Bottle habit,'' 54. 



205 



206 



INDEX 



Bottles, feeding-, 104, 105. 
Bowels, in nursing mother, 47. 
in intestinal indigestion, 

101. 
movements of, after the 

first month, 161. 
during first weeks of life, 
161. 
regularity in, 162, 163. 
when milk disagrees with 
child, 50. (See also 
Constipation and Diar- 
rhoea.) 
Bran baths, 20. 
Bread, 141. 

dried, 157. 
Breast-fed infants, mortality 

of, 44. 
Breast-feeding (See Nurs- 
ing.) 
and bottle-feeding com- 
bined, 50. 
Breast-milk. (See also Milk, 
mother's.) 
age for weaning from, 53. 
composition of, 63. 
Broths, 140, 153. 
Bronchitis, food in, 100. 
Bunsen burner, 104, 106. 



Buttermilk, 120, 121. 
Buttocks, care of, 20. 

Cake, 141. 

Canned vegetables, 138. 

Casein milk, 121, 122. 

Cathartics, 178, 192. 

Centrifugal cream, 69. 

Cereals, 124, 139, 140. 

'' Certified '^ milk, 59. 

Chafing, 19, 20. 

Chest, average circumference 

of, table showing, 36, 

37. 
Chicken broth, 153. 
Chicken pox, 184, 185, 186. 
Circumcision, 17. 
Circumference of head and 

chest, table showing 

average, 36, 37. 
Clothing, 21-23. 
during airing, 28. 
in summer, 22. 
in winter, 23. 
Coddled egg, 88, 157. 
Cold sponge baths, 31. 
Colds, causes of, 23. 
food in, 99. 
prevention of, 28, 31. 



INDEX 



207 



Colic, 50, 91. 

in nursing infants, 52. 
symptoms of, 179. 
treatment of, 95, 96, 179, 
180. 
Composition of cow ^s milk, 62. 
of formulas from seven per 

cent, milk, 72, 73. 
of formulas from whole 

milk, 79. 
of mother ^s milk, 43. 
Condensed milk, 88, 118-120. 
(See also Milk, con- 
densed.) 
Constipation, 50, 52, 78, 85, 
96, 97. 
chronic, changes in food in- 
dicated by, 96, 97. 
cream for, 135. 
milk of magnesia in, 64. 
orange juice for, 88, 97. 
treatment of, 189-191. 
weak food and, 85. 
Convulsions, treatment for, 

176, 177. 
Cow^s milk. (See Milk.) 
Cream, 69. 

Cream for older children, 133, 
134. 



Cream in vomiting, 93, 94. 

method of obtaining, 69. 

purchased in bulk, 60. 

richness of, 69. 
Cream-dipper, 68. 
Croup, membranous, 181. 

simple or spasmodic, 181. 
Cry, abnormal, 168, 169. 

at night, 170. 

importance of, 168. 

normal, 168. 
Curds and whey, 154. 

Dentition, 37-39. 

food in, 99. 
Desserts for young children, 

141, 142. 
Diarrhoea, treatment of, 191, 
192. 
use of band in, 22. 
Diet after weaning, 56, 57. 
during third year, 129, 130. 
for child of 12 months, 123, 

124. 
from eighteenth month to 
end of second year, 
126, 127. 
Diet from fourteenth to eigh- 
teenth month, 125, 126. 



208 



INDEX 



Diet in indigestion, 103, 104, 
145. 
in relieving constipation, 

190, 191. 
of nursing mother, 46, 47. 

Digestion, conditions influenc- 
ing, 101, 102. 

Dilatation of the stomach, 
83, 91. 

Diphtheria, 184, 185, 186. 
of the larynx. (See Mem- 
branous croup.) 

Dirt-eating, 192, 194. 

Dressing and undressing, po- 
sition in, 22. 

Dried milk, 88. 



Ear, foreign bodies in, 179. 

Earache, 180. 

Eczema, omission of tub bath 

in, 16. 
Egg, coddled, 88, 157. 

white of. (See White of 

Eggs, for older children. 135, 
136. 
fried, 135. 
Eggs, idiosyncrasy to, 136. 



Eggs not a cause of ''bilous- 

ness,'' 135.' 
Enlarged tonsils, 166, 199. 
Exercise, 167. 

for nursing mother, 47, 52. 
'^Eye teeth,'' 37. 
Eyes, care of, 17, 18. 

Fat, in milk, 43, 70, 71. 
Feeding, artificial, 57. 

at night, 111. 

before weaning an aid in 
weaning, 54. 

duration of, 108. 

during first year, 110. 

during second year, 122- 
127. 

during third year, 128, 
129. 

general rules for, 149-152. 

intervals of, 91, 109-111. 

position of child during, 
108. 

regularity in. 111, 112. 

rest after, 109. 
Feeding-bottles, 104, 105. 
Fever, during teething, 38. 

in acute illnesses, 100, 101. 
Flannels, 23. 



INDEX 



209 



Flatulence, changes in food 

indicated by, 95, 96. 
Fontanel, closure of, 34. 
Food, changes in, indicated 
by failure to gain in 
weight, 97, 98. 
by gas in the stomach, 

95. 
by habitual flatulence 

and colic, 95, 96. 
by indigestion, 98, 99, 

100, 101. 
by lack of appetite, 

101. 
by serious acute ill- 
ness, 100. 
by slight indisposition, 

99, 100. 
by vomiting or regurgi- 
tation, 93. 
increase in strength of, 73, 

74, 82, 83, 103. 
increase in quantity of, 82, 

83. 
quantity of, factors deter- 
mining, 91, 92. 
Foreign bodies in the ear, 
179. 
in the nose, 179. 



Foreign bodies swallowed, 

177, 178. 
Foreskin, 17. 
Formulas, food, 152-157. 
for modified milk, 71. 
from whole milk, 78-80. 
from seven per cent, milk, 

72. 
to be used in acute gastric 

indigestion, 100, 103. 
to be used in changing 
from seven per cent, to 
whole milk, 76, 79. 
Fresh air, effects of, 30. 
Fruit juices, 124, 143. 
Fruits, during second year, 
127. 
for older children, 143, 144. 
in diet of nursing mother, 
47. 

Gas in the stomach, 50, 95. 
Gastric indigestion, acute, 

treatment for, 100. 
intervals of feeding in, 110. 
Genital organs, cleansing, 16, 

17. 
German measles, 183, 185, 186. 
Germs in milk, 112. 



210 



INDEX 



Goat^s milk, 88, 89. 
Gravies, 137. 
Gravity cream, 69. 
Gruel, 76, 155, 156. 

for formulas from whole 
milk, 79. 
Guaranteed milk, 59. 

Habits, bad, 192-196. 

Head, average circumference 
of, 36, 37. 
holding up, 34. 

Heating of nursery, 26. 

Height, table showing aver- 
age, 36, 37. 

Hot bath, for convulsions, 
177. 

Hunger and weaning, 55. 

Ice, supply of, 61. 
Illness, and late sitting, 
standing or walking, 
35. 
immediate measures in, 186, 

187. 
of mother, 53. 
Indigestion, acute gastric, 
treatment for, 100. 
and reduction in food, 85. 



Indigestion and teething, 38, 
39. 
in older children, acute, 145, 
146. 
chronic, 145, 147, 149. 
intestinal, fruits and, 144. 
increase in food after, 103, 

104. 
intestinal, food changes in- 
dicated by, 101. 
reduction of food in, 103. 
treatment of, 98, 99. 
vomiting a sign of, 51. 
Infant foods and weight, 33. 
Injections, 189. 
Intestinal indigestion, 101, 

144. 
Ipecac for croup, 182. 

Jellies, 155, 156. 
Jersey milk, 103. 
Junket, 154. 

Kissing, objections to, 176. 

Laughing, 34. 
Lifting children, 170, 171. 
Lime water, 156. 
use of, 51, 64, 93. 



INDEX 



211 



-^^& 



Magnesia, milk of, for con- 
stipation, 64. 
Malted milk, 65. 
Maltose, 65, 66. 
in constipation, 97. 
preparations of, 65. 
vomiting aggravated by, 94. 
Massage for relieving consti- 
pation, 190, 191. 
Mastication, 150. 
Masturbation, 195, 196. 
Meals, during second year, 
122. 
during third year, 128. 
from fourth to tenth year, 
133. 
Measles, 182, 183, 185, 186. 

food in, 100. 
Meat pulp, 154. 
Meat, for young children, 136, 

137. 
Mellin^s food^ 65. 
Membranous croup, 181. 
Menstruation, in nursing 

mothers, 48. 
Milk, acid reaction of, 63, 64. 
addition of other foods to, 

86-88. 
bottled, 60. 



care of, in the home, 59, 

60. 
casein, 121, 122. 
Milk, certified, 59. _ __-,.^ 
cleanliness of, 57, 58. 
condensed, 88, 118-120. 
dried, 88. 
for children from fourth to 

tenth year, 133, 134. 
for children just weaned, 56. 
fresh, 57, 58. 
germs in, 63, 112. 
gosit% 88, 89. 
guaranteed, 59. 
handling, essentials in, 58, 

59. 
Jersey, 103. 
malted, 65. 

mixed or '^herd,^^ 58. 
modified, 62, 66. 

by addition of lime water, 

64. 
by addition of sugar, 64, 

65, 66. 
formulas for, 72, 73, 76, 

79. 
in hot weather, 97. 
in which the fat is twice 
the proteid, 71. 



212 



INDEX 



Milk, mistakes in, 102-104. 
of milk laboratories, 117. 
modified, to diminish salts 
and proteids, 66. 
to secure proper amount 
of fat, 67. 
mother's, affected by men- 
struation, 48. 
affected by nervous con- 
ditions, 47. 
compared with cow 's 

milk, 63, 64. 
composition of, 43. 
disagreement of, with 
child, symptoms of, 50. 
reaction of, 63. 
of magnesia, in constipa- 
tion, 97. 
pasteurized, 113. 

preparation of, 115, 116. 
peptonized, 117. 
preparation of, at home, 
104-107. 
during second year, 122, 
123, 124. 
purchased in bulk, 60. 
quantity of, for older chil- 
dren, 134. 
richness of, 68. 



Milk, selection and care of, 
57-62. 
skimmed, use of^ 93, 94. 
sterilized, 88, 112-114. 
sterilized, digestibility of, 
114. 
keeping of, 114. 
substitutes for fresh, 88, 

89. 
temperature of, 59, 107. 
whole, change to, from seven 
per cent, milk, 75-77. 
formula from, 77-79. 
Milk sugar, addition of, to 
cow's milk, 64, 65. 
cost of, 64. 

substitution for, in consti- 
pation, 97. 
Modified milk. (See Milk.) 
Mortality of infants, 44. 
Mother, nursing, bowels and 
digestion in, 47, 52. 
diet of, 46, 47, 52. 
effect of nervous condi- 
tions on, 47. 
exercise for, 47, 52. 
menstruation in, 48. 
rest for, 47. 
Mother's milk. (See Milk.) 



INDEX 



213 



Mouth, cleansing of, in health, 
18. 
in sprue, 19. 
Mumps, 185, 186. 
Mutton broth, 153. 

Nail-biting, 192^ 193. 

Nap, 164. 

Napkins, care of, 24. 

Nervous conditions in nursing 

mother, 47. 
Nervousness, cause of, 130, 
173. 

prevention of, 173. 
Night, feeding in, 111. 
Nipples, care of, 46. 

rubber, 104^ 105. 
care of, 105. 
Nose, foreign bodies in, 179. 
Nursery, airing, 26. 

furnishings of^ 25. 

heating of, 26. 

temperature of, 26. 

ventilation of, 25. 
Nursery refrigerators, 61. 
Nursing, diet of mother in, 46. 

duration of each, 46. 

during first week of life, 45. 

favorable symptoms in, 48. 



Nursing, frequency of, 45. 
importance of, during first 
two or three months, 
44. 
reason for, 44. 
regularity of, 46. 
unfavorable symptoms iu, 

49, 50. 
when contraindicated, 45. 
Nursing infants and gain in 
weight, 32. 
vomiting in, 51. 
Nursing mother. (See Moth- 
er.) 

Oat gruel or jelly, 156. 
Oat water^ 155. 
Omelets, 135. 

Orange juice, addition of, to 
milk, 88. 
in constipation, 88, 97. 
Overfeeding, 83^ 90. 

Pacifiers, 165, 192, 193. 
Pasteurizers, 113. 
Pasteurizing, 113. 

effects of, 115. 

method of, 115. 
Pastry, 142. 



214 



INDEX 



Peptonized milk, 117, 118. 
Peptonizing powder, 117, 118. 
Phillips's milk of magnesia, 

64. 
'^ Plain milk.'' (See Milk.) 
Playing with babies and 
young children, 173, 
174. 
Pneumonia, food in^ 100. 
Powder, peptonizing, 117, 118. 
use of, in chafing, 19, 20. 
in prickly heat, 21. 
Pregnancy, a cause for early 

weaning, 53. 
Prickly heat, 20, 21. 
Proteids in cow's milk, 63. 
in mother's milk, 43. 

use of, 44. 
relation of, to fat, in food 
for infants^ 71. 
Purees, 140. 
Pus in the eyes, 18. 

Reduction in food, causes for, 
85. 
method of, 85. 
return from, to original for- 
mula, 86. 
Eefrigerators, nursery, 61. 



Refusal to take breast, 52. 
Regurgitation, 93, 110. 
Rest for nursing mother, 47. 
Rice gruel or jelly, 156. 
Rice water, 155. 
Rickets, 35, 38. 

condensed milk and, 120. 

due to artificial foods, 57. 
Rocking, 164, 165. 
Rubella. (See German mea- 
sles.) 
Rupture, not caused by cry- 
ing, 170. 



Salads, 139. 

Salt baths, 20. 

Salt solution for cleansing 

the eyes, 17. 
Salts in cow's milk, 63. 

in mother's milk, 43, 44. 
Scarlet fever, 183, 184, 185, 

186. 
Schedule for feeding during 
first year, 110. 
during second year, 124, 

125, 126. 
during third year, 128, 129. 
Scraped beef, 154. 



INDEX 



215 



Scurvy, 166, 187, 188. 

condensed milk and, 120. 

due to artificial foods, 57. 
Scurvy, sterilized milk and, 

114. 
Second year, feeding during, 

122-127. 
Separator, 69. 

Seven per cent, milk, 67. 
(See also Top-milk.) 

change from, to whole milk, 
75, 77. 

formulas from, 72. 

method of obtaining, 71. 
Sitting alone, 34. 
Skimmed milk, use of, 93, 94. 
Skimming milk, 65, 69. 
Skin, care of, 19-21. * 

Sleep, 163, 164, 167. 

disturbed, 165, 166. 
Sleeping, out of doors, 30. 
Sleeplessness, 165. 
Soda, bicarbonate of, in sprue, 

19. 
Sore throat, food in, 99. 
Soups for small children, 140. 
Sponge bath, cold, 31. 
Sponges, 16. 
Sprue, 18, 19. 



Standing alone, 34. 
Sterilization of milk pails, 

bottles, etc., 59. 
Sterilized milk, 88, 112-114. 
Stomach, gas in, 95, 96. 
^'Stomach teeth, ^^ 38. 
Stools, appearance of, 161. 
brown or black, 155, 156, 

161. 
dry, 78. 
'^Straight milk.'' (See Milk.) 
Substitutes for fresh milk, 88, 

89. 
Sucking, 192, 193. 
Sugar, granulated, 64. 
in cow's milk, 66. 
in modifying milk, 67. 
in mother's milk, 43. 
Sugar, milk. (See Milk 
sugar.) 
vomiting aggravated by, 94. 
Summer, clothing in, 22. 
modifications in food in, 

97. 
sterilized milk in, 112, 113. 
Suppositories, 190. 
Sweet oil in chafing, 20. 
Sweets for young children, 
141, 142. 



216 



INDEX 



Syphilis, 166. 

Syringe for use with infants, 

189. 
Talking, 35, 36. 
Teeth, first set of, time of 
appearance of, 37, 38. 
Teething, symptoms of, 38, 39, 
weight and, 33, 39. 
(See also Dentition.) 
Temperature, for bathing, 15. 
for out of door airings, 29. 
Temperature of children, 
high, 171, 172. 
in illness, 172. 
method of taking, 172. 
normal, 171. 
of milk^ 61. 

testing, 106, 107. 
of nursery, 26. 
of refrigerators, 61. 
of water for cold sponge 
bath, 31. 
for hot bath, 177. 
Thermometer, dairy, 107. 
'^Thermos bottle.'^ (See 

Vacuum bottle.) 
Third year, feeding during, 

128, 129. 
Thrush, 18^ 19. 



Tonsil, enlarged, 166, 199. 
Top-milk, definition of, 67. 

fat in, 68. 
Top-milk, removal of, 60, 68, 
69, 102, 103. 
seven per cent., method of 
obtaining, 69. 
Toys, first reaching for, 34. 
means of training, 175. 
selection of, 174, 175. 
Training, a preventive of con- 
stipation, 189. 
and illness, 187. 
in regular feeding, 112. 
in regularity of bowel 
movements, 162, 163. 
Tub bath, age for, 15. 
Tuberculosis, a contraindica- 
tion to maternal nurs- 
ing, 45. 

Underclothing, in summer, 22. 
in cold weather, 23. 

Vaccination, 196, 197. 
Vacuum bottle, uses, 62. 

objections to^ 62. 
Veal broth, 153. 
Ventilation of nursery, 26. 



INDEX 



217 



Vegetables, for small chil- 
dren, 137-139. 

canned, 138. 
Vinegar and water, use of, 

in prickly heat, 21. 
Vomiting, 78. 

causes of, 93. 

changes in food indicated 
by, 93, 94. 

changes in intervals of feed- 
ing indicated by, 94. 

in acute gastric indigestion, 
99. 

in nursing infants, 50, 51. 

in teething, 38. 

intervals of feeding and, 
109. 

quantity of food in, 93. 

symptom that milk dis- 
agrees with child, 50. 

Walker-Gordon milk labora- 
tories, 115, 117. 

Walking, 35. 

Washcloths, 16. 

Water, boiled, in acute gas- 
tric indigestion, 100. 
during first two days of 
life, 45. 



Water, during second year, 
127. 
in acute illness, 100. 
in hot weather, 97. 
in modifying milk, 64. 
in mother ^s milk, 43, 44. 
in weaning, 54. 
to dilute breast-milk, 51. 
Weaning from bottle, 54, 55, 
124. 
age for, 54. 

delayed, objections to, 54. 
method of, 55. 
from breast, age for, 53. 
diet after, 55, 56, 57. 
due to loss of weight, 49. 
early, reasons for, 53. 
how to overcome difB.cul- 

ties of, 54. 
in summer, 53. 
loss of weight at, 32. 
method of, 53, 54. 
when milk disagrees with 
child, 50, 51. 
Weighing, frequency of, 31. 
Weight, after weaning, 56. 
at birth, 33. 

during first weeks of arti- 
ficial feeding, 84. 



218 



INDEX 



Weight, failure to gain in, 
and food, 97, 98. 
treatment of, 97, 98. 
gain in, during first year, 
32, 33. 
in bottle-fed and nursing 
infants, 32. 
importance of, 31. 
in second year, 34. 
overfeeding and, 90, 91. 
record of, 31. 
strength and, 33. 
table showing average, 36, 

37. 
teething and, 33, 39. 
weaning and, 47, 50. 
Weight charts, 201, 202. 



Wheat gruel or jelly, 156. 

Wheat water, 155. 

Whey, 153. 

White of egg, addition of, to 

milk, 87. 
digestibility of, 135. 
Whole milk, change to, from 

seven per cent, milk, 

75-77. 
formulas from, 78-80. 
Whooping cough, 184, 185, 

180. 
Windows open at night, 26. 
Winter, clothing in, 23. 

Yolk of eggy digestibility of, 
135. 



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